| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $104.69 | $104.69 | $690.00 | |
Aetna
| Professional | $102.23 | $104.69 | $690.00 | |
Anthem BCBS
| Professional | $104.69 | $104.69 | $105.73 | |
Hometown Health
| Professional | $107.16 | $123.17 | $200.00 |