| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $26.92 | $38.02 | $97.72 |
Cigna
| Facility | 26 | $6.76 | $31.62 | $45.71 |
Medical Mutual of Ohio
| Facility | 26 | $6.76 | $31.62 | $45.71 |
SummaCare
| Facility | 26 | $213.80 | $213.80 | $213.80 |