| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $126.10 | $126.10 | $126.10 | |
Aetna
| Professional | $126.10 | $126.10 | $126.10 | |
CareFirst
| Professional | $168.00 | $168.00 | $183.12 | |
Kaiser Permanente
| Professional | $146.58 | $318.18 | $318.18 |