| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $125.89 | $125.89 | $125.89 | |
Aetna
| Professional | $125.89 | $125.89 | $218.78 | |
CareFirst
| Professional | $107.15 | $107.15 | $107.15 | |
Kaiser Permanente
| Professional | $95.50 | $109.65 | $169.82 | |
United
| Professional | $147.91 | $147.91 | $169.82 |