| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $160.56 | $160.56 | $160.56 | |
Aetna
| Professional | $160.56 | $160.56 | $160.56 | |
CareFirst
| Professional | $362.67 | $362.67 | $362.67 | |
Cigna
| Professional | $278.88 | $278.88 | $278.88 | |
Kaiser Permanente
| Professional | $213.76 | $213.76 | $649.00 | |
United
| Professional | $187.20 | $264.32 | $361.24 |