| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,491.58 | $6,396.00 | $11,298.00 | |
Aetna
| Facility | 50 | $12,042.00 | $12,042.00 | $12,699.00 |
Horizon BCBS
| Facility | $18,142.74 | $20,343.41 | $45,659.04 | |
United
| Facility | $5,682.00 | $9,969.00 | $19,696.00 |