| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $100.47 | $100.47 | $100.47 | |
Aetna
| Professional | $100.47 | $100.47 | $100.47 | |
CareFirst
| Professional | $141.00 | $141.00 | $153.69 | |
Kaiser Permanente
| Professional | $117.13 | $253.60 | $253.60 |