| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $81.28 | $81.28 | $81.28 | |
Cigna
| Facility | $39.81 | $39.81 | $39.81 | |
Cigna
| Professional | $23.99 | $39.81 | $50.12 | |
Medica
| Facility | $20.89 | $20.89 | $48.98 | |
Wellmark
| Professional | $23.99 | $23.99 | $23.99 |