| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $82.37 | $110.40 | $110.40 | |
Medica
| Facility | $103.36 | $162.19 | $323.08 | |
Midlands
| Facility | $195.05 | $240.88 | $314.54 | |
Sanford Health Plan
| Professional | $121.94 | $181.95 | $226.42 | |
Sanford Health Plan
| Professional | 80 | $45.30 | $45.30 | $45.30 |
Sanford Health Plan
| Professional | AS | $45.30 | $45.30 | $45.30 |
United
| Facility | $821.00 | $821.00 | $821.00 |