| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.26 | $1.26 | $1.26 | |
Aetna
| Professional | $1.26 | $1.26 | $1.26 | |
CareFirst
| Professional | $72.00 | $72.00 | $72.00 | |
Cigna
| Professional | $196.48 | $196.48 | $196.48 | |
Kaiser Permanente
| Professional | $266.00 | $266.00 | $266.00 |