| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $75.86 | $79.43 | $95.50 | |
Hometown Health
| Professional | $18.62 | $75.86 | $75.86 | |
Hometown Health
| Professional | $18.62 | $18.62 | $18.62 | |
United
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Professional | $41.69 | $41.69 | $41.69 |