| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,265.80 | $8,511.38 | $15,488.17 | |
Aetna
| Facility | 22 | $9,120.11 | $9,120.11 | $9,120.11 |
Horizon BCBS
| Facility | $20,892.96 | $33,884.42 | $52,480.75 | |
United
| Facility | $4,786.30 | $10,000.00 | $25,118.86 |