| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.99 | $34.67 | $38.02 | |
Aetna
| Professional | $19.05 | $26.92 | $38.02 | |
Cigna
| Professional | $19.05 | $19.05 | $19.05 | |
Medical Mutual of Ohio
| Professional | $19.05 | $19.05 | $19.05 | |
Molina
| Professional | $39.81 | $50.12 | $60.26 | |
SummaCare
| Professional | $50.12 | $60.26 | $75.86 | |
United
| Professional | $21.38 | $30.20 | $54.95 |