| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.13 | $77.13 | $77.13 | |
Aetna
| Professional | $77.13 | $77.13 | $77.13 | |
CareFirst
| Professional | $99.01 | $99.01 | $128.82 | |
Cigna
| Professional | $78.68 | $78.68 | $78.68 | |
Kaiser Permanente
| Professional | $122.49 | $122.49 | $374.08 | |
United
| Professional | $62.68 | $94.01 | $197.75 |