| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $93.33 | $93.33 | $93.33 | |
Cigna
| Facility | $43.65 | $43.65 | $43.65 | |
Cigna
| Professional | $26.30 | $43.65 | $53.70 | |
Medica
| Facility | $20.42 | $20.42 | $47.86 | |
Wellmark
| Professional | $23.99 | $23.99 | $23.99 |