| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.22 | $66.22 | $66.22 | |
Aetna
| Professional | $66.22 | $66.22 | $66.22 | |
CareFirst
| Professional | $45.81 | $45.81 | $45.81 | |
Kaiser Permanente
| Professional | $69.56 | $69.56 | $138.10 | |
United
| Professional | $23.14 | $37.33 | $170.12 |