| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.41 | $109.41 | $109.41 | |
Aetna
| Professional | $109.41 | $109.41 | $109.41 | |
CareFirst
| Professional | $240.00 | $240.00 | $261.60 | |
Kaiser Permanente
| Professional | $127.88 | $276.18 | $276.18 |