| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $108.34 | $108.34 | $108.34 | |
Aetna
| Professional | $108.34 | $108.34 | $108.34 | |
CareFirst
| Professional | $142.00 | $142.00 | $180.95 | |
Cigna
| Professional | $120.74 | $120.74 | $120.74 | |
Kaiser Permanente
| Professional | $172.06 | $172.06 | $525.45 | |
United
| Professional | $88.04 | $132.05 | $205.55 |