| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $191.09 | $191.09 | $191.09 | |
Aetna
| Professional | $191.09 | $191.09 | $191.09 | |
CareFirst
| Professional | $390.00 | $410.00 | $446.90 | |
Kaiser Permanente
| Professional | $222.49 | $481.81 | $481.81 |