| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $109.55 | $109.55 | $109.55 | |
Medica
| Facility | $135.56 | $185.14 | $275.76 | |
Midlands
| Facility | $184.00 | $247.70 | $323.29 | |
Sanford Health Plan
| Professional | $131.16 | $172.90 | $200.54 | |
United
| Facility | $821.00 | $821.00 | $821.00 |