| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $369.68 | $369.68 | $369.68 | |
Aetna
| Professional | $369.68 | $369.68 | $421.37 | |
CareFirst
| Professional | $5,150.00 | $5,150.00 | $5,150.00 | |
Kaiser Permanente
| Professional | $7,744.00 | $7,744.00 | $7,744.00 |