| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.22 | $104.22 | $212.83 | |
Aetna
| Professional | $104.22 | $104.22 | $212.83 | |
Cigna
| Facility | $162.84 | $162.84 | $162.84 | |
Hometown Health
| Professional | $191.47 | $191.47 | $234.98 | |
Hometown Health
| Facility | $179.97 | $179.97 | $179.97 |