| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $245.48 | $245.48 | $245.48 | |
Aetna
| Professional | $245.48 | $245.48 | $245.48 | |
CareFirst
| Professional | $135.50 | $135.50 | $135.50 | |
Kaiser Permanente
| Professional | $257.89 | $257.89 | $511.96 | |
United
| Professional | $85.78 | $143.27 | $630.64 |