| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $278.42 | $278.42 | $278.42 | |
Aetna
| Professional | $116.87 | $126.10 | $139.38 | |
CareFirst
| Professional | $152.10 | $168.00 | $192.02 | |
Kaiser Permanente
| Professional | $147.00 | $189.63 | $300.33 |