| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $438.05 | $6,450.00 | $11,298.00 | |
Aetna
| Facility | 50 | $4,731.49 | $7,294.81 | $10,695.83 |
Horizon BCBS
| Facility | $15,424.19 | $16,829.91 | $32,096.34 | |
United
| Facility | $5,378.00 | $8,305.00 | $14,121.00 |