| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $49.98 | $67.72 | $67.72 | |
Medica
| Facility | $62.36 | $101.29 | $181.76 | |
Midlands
| Facility | $103.34 | $134.44 | $200.21 | |
Sanford Health Plan
| Professional | $65.79 | $92.60 | $124.20 | |
United
| Facility | $821.00 | $821.00 | $821.00 |