| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $171.19 | $171.19 | $171.19 | |
Aetna
| Professional | $171.19 | $171.19 | $171.19 | |
CareFirst
| Professional | $172.00 | $172.00 | $172.00 | |
Cigna
| Professional | $164.32 | $164.32 | $164.32 | |
Kaiser Permanente
| Professional | $208.76 | $208.76 | $637.54 | |
United
| Professional | $106.82 | $160.22 | $243.74 |