| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $512.86 | $512.86 | $512.86 | |
Aetna
| Professional | $512.86 | $512.86 | $1,258.93 | |
Medica
| Facility | $741.31 | $933.25 | $1,737.80 | |
Wellmark
| Professional | $251.19 | $251.19 | $251.19 |