| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.53 | $109.53 | $109.53 | |
Aetna
| Professional | $109.53 | $109.53 | $153.37 | |
CareFirst
| Professional | $178.04 | $178.04 | $178.04 | |
Cigna
| Professional | $103.66 | $103.66 | $103.66 | |
Kaiser Permanente
| Professional | $173.95 | $173.95 | $531.25 | |
United
| Professional | $89.01 | $133.51 | $249.94 |