| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $127.50 | $127.50 | $127.50 | |
Aetna
| Professional | $127.50 | $127.50 | $127.50 | |
CareFirst
| Professional | $127.50 | $127.50 | $127.50 | |
Cigna
| Facility | $127.50 | $127.50 | $127.50 | |
United
| Professional | $113.75 | $125.00 | $202.60 |