| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $249.83 | $249.83 | $249.83 | |
Aetna
| Professional | $249.83 | $249.83 | $249.83 | |
CareFirst
| Professional | $505.80 | $505.80 | $551.32 | |
Kaiser Permanente
| Professional | $290.04 | $629.61 | $629.61 |