| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $905.44 | $905.44 | $905.44 | |
CareSource
| Facility | $491.30 | $589.55 | $729.70 | |
Cigna
| Facility | $594.32 | $594.32 | $594.32 | |
Medical Mutual of Ohio
| Facility | $594.32 | $594.32 | $594.32 |