| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $86.43 | $86.43 | $86.43 | |
Aetna
| Professional | $86.43 | $86.43 | $86.43 | |
CareFirst
| Professional | $131.91 | $131.91 | $131.91 | |
Kaiser Permanente
| Professional | $88.65 | $88.65 | $269.17 | |
United
| Professional | $52.24 | $83.36 | $118.82 |