| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $94.86 | $107.51 | $126.49 | |
Aetna
| Professional | $60.65 | $127.30 | $382.03 | |
Aetna
| Professional | 25 | $128.72 | $128.72 | $128.72 |
CareFirst
| Professional | $101.81 | $101.81 | $109.61 | |
Kaiser Permanente
| Professional | $142.03 | $142.03 | $297.08 | |
United
| Professional | $86.65 | $148.77 | $292.74 |