| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | AA | $239.88 | $436.52 | $478.63 |
Aetna
| Professional | QZ | $371.54 | $478.63 | $616.60 |
Cigna
| Professional | AA | $354.81 | $398.11 | $436.52 |
Wellmark
| Professional | AA | $371.54 | $371.54 | $371.54 |
Wellmark
| Professional | QZ | $288.40 | $288.40 | $288.40 |