| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.00 | $75.00 | $75.00 | |
Aetna
| Professional | $75.00 | $75.00 | $75.00 | |
Cigna
| Professional | $98.27 | $98.27 | $98.27 | |
Medica
| Facility | $126.23 | $126.75 | $134.41 | |
Midlands
| Professional | $109.48 | $126.11 | $126.11 | |
Wellmark
| Professional | $105.00 | $105.00 | $105.00 |