| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $492.89 | $4,294.00 | $9,860.00 | |
Aetna
| Facility | 54 | $369.67 | $369.67 | $463.63 |
Horizon BCBS
| Facility | $3,890.91 | $3,890.91 | $3,890.91 | |
United
| Facility | $3,705.00 | $5,265.00 | $10,536.00 |