| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $616.14 | $6,628.00 | $11,535.00 | |
Aetna
| Facility | 50 | $12,825.00 | $12,825.00 | $12,825.00 |
Horizon BCBS
| Facility | $36,080.94 | $37,272.08 | $50,833.85 | |
United
| Facility | $6,066.00 | $12,315.00 | $27,214.00 |