| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $40.04 | $40.04 | $40.04 | |
Aetna
| Professional | $40.04 | $40.04 | $58.75 | |
CareFirst
| Professional | $52.00 | $52.00 | $66.88 | |
Cigna
| Professional | $52.69 | $52.69 | $52.69 | |
Kaiser Permanente
| Professional | $63.59 | $63.59 | $194.20 | |
United
| Professional | $32.54 | $48.81 | $91.37 |