| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $999.03 | $999.03 | $999.03 | |
Aetna
| Professional | $999.03 | $999.03 | $999.03 | |
Hometown Health
| Professional | $127.38 | $200.00 | $229.28 | |
Hometown Health
| Professional | $127.38 | $127.38 | $191.07 |