| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $114.26 | $114.26 | $119.00 | |
Hometown Health
| Professional | $100.00 | $110.00 | $350.00 | |
Hometown Health
| Facility | $32.92 | $32.92 | $32.92 | |
United
| Professional | $134.22 | $134.22 | $134.22 |