| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.54 | $7.54 | $7.54 | |
Aetna
| Professional | $7.54 | $9.42 | $689.75 | |
Medica
| Facility | $10.78 | $32.89 | $38.86 | |
Midlands
| Professional | $480.40 | $480.40 | $480.40 | |
Wellmark
| Professional | $171.40 | $171.40 | $171.40 |