| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $86.44 | $86.44 | $86.44 | |
Medica
| Facility | $101.72 | $146.08 | $226.95 | |
Midlands
| Facility | $131.46 | $209.75 | $261.75 | |
Sanford Health Plan
| Professional | $101.61 | $136.93 | $160.43 | |
United
| Facility | $821.00 | $821.00 | $821.00 |