| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $700.88 | $855.25 | $1,429.75 | |
Aetna
| Professional | $700.88 | $855.25 | $1,136.89 | |
Hometown Health
| Professional | $200.00 | $400.00 | $571.62 | |
Hometown Health
| Facility | $873.16 | $873.16 | $873.16 |