| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $922.39 | $6,180.00 | $11,798.00 | |
Aetna
| Facility | 50 | $17,511.00 | $17,511.00 | $17,511.00 |
Horizon BCBS
| Facility | $14,478.58 | $15,715.96 | $33,122.22 | |
United
| Facility | $5,682.00 | $10,536.00 | $23,291.00 |