| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $153.83 | $153.83 | $153.83 | |
Aetna
| Professional | $153.83 | $153.83 | $153.83 | |
CareFirst
| Professional | $180.00 | $180.00 | $196.20 | |
Kaiser Permanente
| Professional | $178.80 | $387.27 | $387.27 |