| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $157.11 | $157.11 | $157.11 | |
Aetna
| Professional | $157.11 | $157.11 | $157.11 | |
CareFirst
| Professional | $208.00 | $271.00 | $295.39 | |
Kaiser Permanente
| Professional | $182.61 | $394.73 | $394.73 |