| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $70.00 | $70.00 | $70.00 | |
Aetna
| Professional | $70.00 | $70.00 | $70.00 | |
CareFirst
| Professional | $140.00 | $140.00 | $140.00 | |
Kaiser Permanente
| Professional | $51.49 | $110.92 | $110.92 |