| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,998.68 | $4,998.68 | $4,998.68 | |
Aetna
| Professional | $4,998.68 | $4,998.68 | $4,998.68 | |
Hometown Health
| Professional | $100.00 | $200.00 | $493.00 | |
United
| Professional | $888.93 | $888.93 | $888.93 |