| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $51.29 | $51.29 | $51.29 | |
AmeriHealth
| Professional | $83.18 | $83.18 | $83.18 | |
Horizon BCBS
| Facility | $194.98 | $10,715.19 | $25,703.96 | |
United
| Professional | $45.71 | $45.71 | $46.77 |