| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $531.89 | $531.89 | $737.93 | |
Aetna
| Professional | $531.89 | $531.89 | $897.01 | |
Hometown Health
| Professional | $200.00 | $350.00 | $425.00 | |
Hometown Health
| Facility | $873.16 | $873.16 | $873.16 |