| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | QZ | $959.42 | $959.42 | $959.42 |
Cigna
| Professional | AA | $342.85 | $404.25 | $428.56 |
Wellmark
| Professional | AA | $370.00 | $370.00 | $370.00 |
Wellmark
| Professional | QZ | $288.50 | $288.50 | $288.50 |