| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $144.00 | $144.00 | $144.00 | |
Ambetter
| Facility | $157.54 | $157.54 | $204.28 | |
Cigna
| Facility | $19.00 | $25.00 | $35.00 | |
Medical Mutual of Ohio
| Facility | $19.00 | $19.00 | $25.00 |