| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $113.30 | $113.30 | $113.30 | |
Aetna
| Professional | $113.30 | $113.30 | $113.30 | |
CareFirst
| Professional | $199.70 | $199.70 | $199.70 | |
Kaiser Permanente
| Professional | $175.94 | $175.94 | $404.63 | |
United
| Professional | $80.62 | $134.84 | $243.63 |