| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $387.95 | $6,338.00 | $11,298.00 | |
Aetna
| Facility | 50 | $4,963.50 | $4,963.50 | $4,963.50 |
Horizon BCBS
| Facility | $7,587.62 | $8,385.14 | $14,882.11 | |
United
| Facility | $2,879.00 | $5,864.00 | $10,105.00 |