| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $332.41 | $332.41 | $332.41 | |
Aetna
| Professional | $332.41 | $332.41 | $332.41 | |
CareFirst
| Professional | $478.80 | $478.80 | $521.89 | |
Kaiser Permanente
| Professional | $386.40 | $837.51 | $837.51 |