| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $295.54 | $694.52 | $1,307.00 | |
CareSource
| Facility | $311.27 | $311.27 | $453.26 | |
Cigna
| Facility | $491.33 | $491.33 | $491.33 | |
Medical Mutual of Ohio
| Facility | $491.33 | $491.33 | $491.33 |