| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $78.36 | $78.36 | $78.36 | |
Aetna
| Professional | $78.36 | $78.36 | $78.36 | |
CareFirst
| Professional | $122.88 | $123.46 | $123.46 | |
Kaiser Permanente
| Professional | $82.27 | $82.27 | $249.78 | |
United
| Professional | $50.26 | $75.56 | $110.26 |