| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $124.12 | $124.12 | $124.12 | |
Aetna
| Professional | $124.12 | $124.12 | $124.12 | |
CareFirst
| Professional | $163.00 | $163.00 | $163.00 | |
Cigna
| Professional | $124.80 | $124.80 | $124.80 | |
Kaiser Permanente
| Professional | $197.12 | $197.12 | $601.98 | |
United
| Professional | $100.86 | $151.30 | $227.32 |