| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $39.81 | $39.81 | $39.81 | |
Aetna
| Professional | $39.81 | $39.81 | $39.81 | |
Cigna
| Facility | $758.58 | $758.58 | $954.99 | |
Cigna
| Professional | $512.86 | $512.86 | $630.96 | |
Medica
| Facility | $39.81 | $67.61 | $100.00 | |
Wellmark
| Professional | $97.72 | $97.72 | $97.72 |