| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $54.86 | $54.86 | $54.86 | |
Aetna
| Professional | $54.86 | $54.86 | $54.86 | |
CareFirst
| Professional | $58.50 | $58.50 | $65.00 | |
Kaiser Permanente
| Professional | $63.41 | $138.83 | $138.83 |