| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $56.01 | $126.87 | $166.30 | |
Cigna
| Professional | $123.66 | $128.26 | $128.26 | |
Hometown Health
| Professional | $0.65 | $0.73 | $72.50 | |
Hometown Health
| Professional | $0.73 | $0.73 | $0.73 | |
United
| Professional | $129.69 | $170.49 | $267.24 |