| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.87 | $76.87 | $76.87 | |
Aetna
| Professional | $76.87 | $76.87 | $76.87 | |
CareFirst
| Professional | $104.85 | $104.85 | $128.38 | |
Cigna
| Professional | $78.42 | $78.42 | $78.42 | |
Kaiser Permanente
| Professional | $122.08 | $122.08 | $372.84 | |
United
| Professional | $62.47 | $93.70 | $140.79 |