| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.55 | $75.55 | $75.55 | |
Aetna
| Professional | $75.55 | $75.55 | $88.52 | |
CareFirst
| Professional | $75.55 | $75.55 | $75.55 | |
Cigna
| Professional | $75.55 | $75.55 | $75.55 | |
United
| Professional | $88.88 | $88.88 | $94.21 |