| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $68.59 | $68.59 | $68.59 | |
Aetna
| Professional | $68.59 | $68.59 | $68.59 | |
CareFirst
| Professional | $135.90 | $135.90 | $151.00 | |
Kaiser Permanente
| Professional | $79.72 | $172.60 | $172.60 |