| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $41.45 | $41.45 | $41.45 | |
Aetna
| Professional | $41.45 | $41.45 | $41.45 | |
CareFirst
| Professional | $70.20 | $70.20 | $76.52 | |
Kaiser Permanente
| Professional | $48.16 | $104.30 | $104.30 |