| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $261.80 | $261.80 | $261.80 | |
Aetna
| Professional | $261.80 | $261.80 | $4,923.67 | |
CareFirst
| Professional | $1,837.00 | $1,837.00 | $1,837.00 | |
Kaiser Permanente
| Professional | $2,904.00 | $2,904.00 | $2,904.00 |