| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $84.22 | $84.22 | $84.22 | |
Aetna
| Professional | $84.22 | $84.22 | $84.22 | |
CareFirst
| Professional | $114.87 | $114.87 | $114.87 | |
Cigna
| Professional | $107.35 | $107.35 | $107.35 | |
Kaiser Permanente
| Professional | $133.75 | $133.75 | $408.47 | |
United
| Professional | $68.44 | $102.66 | $159.79 |