| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $175.28 | $175.28 | $175.28 | |
Aetna
| Professional | $143.75 | $175.28 | $175.28 | |
CareFirst
| Professional | $121.91 | $121.91 | $162.13 | |
Cigna
| Professional | $148.66 | $148.66 | $178.12 |