| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $76.83 | $76.83 | $76.83 | |
Aetna
| Professional | $76.83 | $76.83 | $76.83 | |
CareFirst
| Professional | $77.00 | $77.00 | $77.00 | |
Cigna
| Professional | $65.75 | $65.75 | $65.75 | |
Kaiser Permanente
| Professional | $93.69 | $93.69 | $286.12 | |
United
| Professional | $47.94 | $71.91 | $122.91 |