| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $164.09 | $164.09 | $164.09 | |
CareFirst
| Professional | $271.51 | $271.51 | $271.51 | |
Kaiser Permanente
| Professional | $187.68 | $187.68 | $187.68 | |
United
| Professional | $105.44 | $158.15 | $158.15 |