| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.09 | $86.25 | $101.47 | |
Aetna
| Professional | $20.92 | $88.41 | $134.94 | |
Aetna
| Professional | 25 | $20.57 | $101.95 | $101.95 |
CareFirst
| Professional | $69.56 | $69.56 | $88.98 | |
Kaiser Permanente
| Professional | $115.67 | $115.67 | $241.16 | |
United
| Professional | $63.86 | $105.02 | $237.64 |