| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $690.00 | $690.00 | $690.00 | |
Aetna
| Professional | $102.23 | $690.00 | $690.00 | |
Anthem BCBS
| Professional | $37.97 | $37.97 | $58.39 | |
CareSource
| Facility | $86.31 | $86.31 | $105.48 | |
Cigna
| Professional | $62.16 | $62.16 | $62.16 | |
Medical Mutual of Ohio
| Facility | $85.00 | $85.00 | $85.00 |