| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $77.59 | $77.59 | $77.59 | |
Aetna
| Professional | $77.59 | $77.59 | $77.59 | |
CareFirst
| Professional | $78.00 | $78.00 | $99.51 | |
Cigna
| Professional | $71.20 | $71.20 | $71.20 | |
Kaiser Permanente
| Professional | $94.61 | $94.61 | $288.95 | |
United
| Professional | $48.41 | $72.62 | $102.88 |