| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $57.53 | $57.53 | $57.53 | |
Aetna
| Professional | $57.53 | $57.53 | $57.53 | |
CareFirst
| Professional | $54.14 | $54.14 | $54.14 | |
Cigna
| Facility | $57.53 | $57.53 | $57.53 | |
United
| Professional | $51.32 | $56.40 | $91.41 |