| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $322.57 | $322.57 | $322.57 | |
Aetna
| Professional | $322.57 | $322.57 | $322.57 | |
CareFirst
| Professional | $635.50 | $635.50 | $692.70 | |
Kaiser Permanente
| Professional | $374.96 | $811.25 | $811.25 |