| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $53.53 | $53.53 | $53.53 | |
Aetna
| Professional | $53.53 | $53.53 | $53.53 | |
CareFirst
| Professional | $18.00 | $18.00 | $19.62 | |
Kaiser Permanente
| Professional | $65.16 | $134.08 | $134.08 |