| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $104.74 | $104.74 | $104.74 | |
Medica
| Facility | $90.00 | $100.00 | $144.94 | |
Medica
| Professional | $135.71 | $135.71 | $135.71 | |
Midlands
| Professional | $109.95 | $109.95 | $135.71 | |
Wellmark
| Professional | $89.27 | $113.00 | $113.00 |