| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $142.05 | $142.05 | $142.05 | |
Aetna
| Professional | $142.05 | $142.05 | $142.05 | |
CareFirst
| Professional | $143.00 | $143.00 | $143.00 | |
Cigna
| Professional | $121.56 | $121.56 | $121.56 | |
Kaiser Permanente
| Professional | $173.23 | $173.23 | $529.01 | |
United
| Professional | $88.64 | $132.94 | $188.35 |