| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $134.90 | $141.25 | $177.83 | |
Aetna
| Facility | 25 | $977.24 | $977.24 | $977.24 |
Cigna
| Facility | $346.74 | $346.74 | $346.74 | |
Hometown Health
| Professional | $1.62 | $169.82 | $245.47 | |
Hometown Health
| Professional | 25 | $1,071.52 | $1,071.52 | $1,071.52 |