| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $25.00 | $25.00 | $25.00 | |
Medica
| Facility | $42.25 | $42.25 | $68.50 | |
Medica
| Professional | $84.07 | $84.07 | $84.07 | |
Midlands
| Facility | $75.00 | $75.00 | $75.00 | |
Midlands
| Professional | $84.07 | $84.07 | $84.07 | |
Wellmark
| Professional | $59.20 | $69.70 | $72.50 |