| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $548.86 | $548.86 | $548.86 | |
Aetna
| Professional | $548.86 | $548.86 | $548.86 | |
Hometown Health
| Professional | $100.00 | $200.00 | $493.00 | |
United
| Professional | $4,800.00 | $4,800.00 | $4,800.00 |