| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $52.48 | $63.10 | $112.20 |
Cigna
| Facility | 26 | $13.49 | $63.10 | $89.13 |
Medical Mutual of Ohio
| Facility | 26 | $13.49 | $63.10 | $89.13 |
SummaCare
| Facility | 26 | $213.80 | $213.80 | $213.80 |