| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.07 | $109.07 | $109.07 | |
Aetna
| Professional | $109.07 | $109.07 | $160.06 | |
CareFirst
| Professional | $143.00 | $143.00 | $182.18 | |
Cigna
| Professional | $128.34 | $128.34 | $128.34 | |
Kaiser Permanente
| Professional | $173.23 | $173.23 | $529.03 | |
United
| Professional | $88.64 | $132.96 | $199.77 |