| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $222.15 | $222.15 | $222.15 | |
CareFirst
| Professional | $476.00 | $476.00 | $476.00 | |
Kaiser Permanente
| Professional | $250.62 | $250.62 | $250.62 | |
United
| Professional | $158.07 | $264.39 | $264.39 |