| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.11 | $16.11 | $16.11 | |
Medica
| Facility | $19.92 | $27.23 | $41.97 | |
Midlands
| Facility | $29.00 | $37.72 | $50.05 | |
Sanford Health Plan
| Professional | $20.11 | $26.67 | $30.40 | |
Sanford Health Plan
| Professional | 80 | $6.05 | $6.05 | $6.05 |
Sanford Health Plan
| Professional | AS | $6.05 | $6.05 | $6.05 |
United
| Facility | $821.00 | $821.00 | $821.00 |