| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $163.19 | $163.19 | $163.19 | |
Aetna
| Professional | $163.19 | $163.19 | $208.90 | |
CareFirst
| Professional | $163.19 | $163.19 | $163.19 | |
Cigna
| Professional | $163.19 | $163.19 | $163.19 | |
Kaiser Permanente
| Professional | $172.80 | $172.80 | $172.80 | |
United
| Professional | $155.19 | $160.00 | $259.32 |