| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $88.76 | $88.76 | $88.76 | |
Aetna
| Professional | $88.76 | $88.76 | $88.76 | |
Anthem BCBS
| Professional | $61.67 | $125.40 | $125.40 | |
Hometown Health
| Professional | $200.00 | $400.00 | $493.00 | |
Hometown Health
| Facility | $323.30 | $323.30 | $323.30 |