| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $64.79 | $64.79 | $64.79 | |
Aetna
| Professional | $64.79 | $64.79 | $64.79 | |
CareFirst
| Professional | $27.00 | $27.00 | $27.00 | |
Kaiser Permanente
| Professional | $75.14 | $162.94 | $162.94 |