| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.30 | $65.30 | $65.30 | |
Aetna
| Professional | $65.30 | $65.30 | $65.30 | |
CareFirst
| Professional | $86.00 | $86.00 | $86.00 | |
Cigna
| Professional | $76.06 | $76.06 | $76.06 | |
Kaiser Permanente
| Professional | $103.70 | $103.70 | $316.69 | |
United
| Professional | $53.06 | $74.18 | $167.42 |