| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.15 | $118.89 | $141.53 | |
Cigna
| Facility | $350.00 | $350.00 | $350.00 | |
Hometown Health
| Professional | $1.14 | $126.00 | $203.00 | |
Hometown Health
| Professional | 25 | $805.25 | $805.25 | $805.25 |