| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,648.85 | $11,892.93 | $19,096.88 | |
Aetna
| Facility | 80 | $6,400.00 | $6,400.00 | $6,400.00 |
Horizon BCBS
| Facility | $10,144.00 | $28,306.58 | $67,834.27 | |
United
| Facility | $5,682.00 | $10,536.00 | $23,291.00 |