| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $208.93 | $208.93 | $208.93 | |
Aetna
| Professional | $102.33 | $169.82 | $208.93 | |
CareFirst
| Professional | $89.13 | $120.23 | $169.82 | |
Kaiser Permanente
| Professional | $158.49 | $245.47 | $524.81 |