| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.65 | $109.65 | $109.65 | |
Aetna
| Professional | $100.00 | $109.65 | $173.78 | |
CareFirst
| Professional | $141.25 | $239.88 | $316.23 | |
Kaiser Permanente
| Professional | $131.83 | $138.04 | $275.42 |