| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Anthem BCBS
| Facility | $684.58 | $1,316.10 | $2,702.95 | |
Cigna
| Facility | $2,503.63 | $2,503.63 | $2,503.63 | |
Medical Mutual of Ohio
| Facility | $2,503.63 | $2,503.63 | $2,503.63 |
Level 4 Diagnostic Tests and Related Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Anthem BCBS
| Facility | $684.58 | $1,316.10 | $2,702.95 | |
Cigna
| Facility | $2,503.63 | $2,503.63 | $2,503.63 | |
Medical Mutual of Ohio
| Facility | $2,503.63 | $2,503.63 | $2,503.63 |