| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $50.12 | $50.12 | $50.12 | |
Aetna
| Professional | $50.12 | $50.12 | $50.12 | |
Cigna
| Professional | $38.90 | $38.90 | $38.90 | |
Medical Mutual of Ohio
| Professional | $38.90 | $38.90 | $38.90 | |
Molina
| Professional | $32.36 | $50.12 | $60.26 | |
SummaCare
| Professional | $50.12 | $60.26 | $75.86 |