| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $246.27 | $246.27 | $246.27 | |
Aetna
| Professional | $246.27 | $246.27 | $246.27 | |
CareFirst
| Professional | $369.90 | $369.90 | $403.19 | |
Kaiser Permanente
| Professional | $285.89 | $619.08 | $619.08 |