| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $37.60 | $37.60 | $37.60 | |
Aetna
| Professional | $14.40 | $14.40 | $422.00 | |
Cigna
| Facility | $34.92 | $34.92 | $34.92 | |
Cigna
| Professional | $5.25 | $5.25 | $34.92 | |
Hometown Health
| Professional | $200.00 | $200.00 | $493.00 |