| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | QZ | $416.87 | $416.87 | $416.87 |
Cigna
| Professional | AA | $354.81 | $398.11 | $436.52 |
Wellmark
| Professional | AA | $371.54 | $371.54 | $371.54 |
Wellmark
| Professional | QX | $165.96 | $204.17 | $204.17 |
Wellmark
| Professional | QZ | $288.40 | $288.40 | $288.40 |