| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.82 | $14.82 | $144.65 | |
Aetna
| Professional | $14.82 | $14.82 | $144.65 | |
Cigna
| Facility | $69.69 | $69.69 | $69.69 | |
Cigna
| Professional | $130.77 | $130.77 | $130.77 | |
Hometown Health
| Professional | $97.09 | $97.09 | $119.15 | |
Hometown Health
| Facility | $77.02 | $77.02 | $77.02 |