| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,151.72 | $1,151.72 | $1,151.72 | |
Aetna
| Professional | $443.71 | $1,151.72 | $1,151.72 | |
Hometown Health
| Professional | $200.00 | $400.00 | $571.62 | |
Hometown Health
| Facility | $873.16 | $873.16 | $873.16 |