| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $131.21 | $131.21 | $131.21 | |
Medica
| Facility | $125.66 | $202.33 | $328.03 | |
Midlands
| Facility | $203.91 | $303.18 | $400.46 | |
Sanford Health Plan
| Professional | $173.74 | $216.18 | $246.47 | |
United
| Facility | $2,000.00 | $2,000.00 | $2,000.00 |