| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $180.20 | $180.20 | $180.20 | |
Aetna
| Professional | $180.20 | $180.20 | $180.20 | |
CareFirst
| Professional | $180.20 | $180.20 | $180.20 | |
Cigna
| Facility | $203.81 | $203.81 | $203.81 | |
Kaiser Permanente
| Professional | $254.68 | $254.68 | $254.68 | |
United
| Professional | $180.15 | $205.63 | $262.02 |