| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1,122.02 | $1,122.02 | $1,122.02 | |
CareSource
| Facility | $562.34 | $645.65 | $741.31 | |
Cigna
| Facility | $977.24 | $977.24 | $977.24 | |
Medical Mutual of Ohio
| Facility | $977.24 | $977.24 | $977.24 |