| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $73.81 | $73.81 | $73.81 | |
Aetna
| Professional | $73.81 | $73.81 | $77.51 | |
CareFirst
| Professional | $66.05 | $66.05 | $66.05 | |
Cigna
| Professional | $72.52 | $72.52 | $72.52 | |
Kaiser Permanente
| Professional | $67.58 | $73.81 | $91.43 | |
United
| Professional | $73.08 | $77.70 | $83.42 | |
Wellpoint
| Professional | $73.81 | $73.81 | $73.81 |