| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $107.56 | $107.56 | $107.56 | |
Aetna
| Professional | $107.56 | $107.56 | $107.56 | |
Cigna
| Professional | $133.06 | $208.24 | $260.30 | |
Medica
| Facility | $107.99 | $129.57 | $543.54 | |
Medica
| Professional | $58.36 | $102.99 | $171.65 | |
Midlands
| Facility | $137.32 | $200.25 | $225.20 | |
Midlands
| Professional | $137.32 | $200.25 | $295.29 | |
Sanford Health Plan
| Professional | $114.43 | $275.70 | $314.36 | |
United
| Professional | $48.06 | $68.66 | $137.32 | |
Wellmark
| Professional | $114.43 | $114.43 | $114.43 |