| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $106.51 | $106.51 | $106.51 | |
Aetna
| Professional | $106.51 | $106.51 | $106.51 | |
CareFirst
| Professional | $107.00 | $111.99 | $136.61 | |
Cigna
| Professional | $125.82 | $125.82 | $125.82 | |
Kaiser Permanente
| Professional | $129.88 | $129.88 | $396.68 | |
United
| Professional | $66.45 | $99.69 | $170.40 |