| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.59 | $77.59 | $77.59 | |
Aetna
| Professional | $77.59 | $77.59 | $77.59 | |
CareFirst
| Professional | $73.87 | $73.87 | $80.52 | |
Kaiser Permanente
| Professional | $169.02 | $169.02 | $169.02 | |
United
| Facility | $645.00 | $1,319.00 | $16,382.00 | |
United
| Professional | $57.46 | $91.13 | $170.21 |