| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $293.75 | $293.75 | $2,290.00 | |
Medica
| Facility | $389.73 | $509.04 | $831.67 | |
Midlands
| Facility | $469.41 | $701.60 | $986.54 | |
Sanford Health Plan
| Professional | $394.01 | $546.97 | $623.61 | |
Sanford Health Plan
| Professional | 80 | $120.97 | $120.97 | $120.97 |
Sanford Health Plan
| Professional | AS | $120.97 | $120.97 | $120.97 |
United
| Facility | $821.00 | $821.00 | $821.00 |