| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $94.87 | $94.87 | $94.87 | |
Aetna
| Professional | $94.87 | $94.87 | $139.21 | |
CareFirst
| Professional | $124.00 | $124.00 | $158.46 | |
Cigna
| Professional | $105.73 | $105.73 | $105.73 | |
Kaiser Permanente
| Professional | $150.66 | $150.66 | $460.14 | |
United
| Professional | $77.09 | $115.64 | $173.76 |