| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $620.09 | $620.09 | $620.09 | |
CareSource
| Facility | $680.51 | $680.51 | $680.51 | |
Cigna
| Facility | $691.08 | $691.08 | $691.08 | |
Kaiser Permanente
| Professional | $585.25 | $760.83 | $3,143.00 |