| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12,113.57 | $12,113.57 | $12,113.57 | |
Medica
| Facility | $367.10 | $579.42 | $1,069.50 | |
Midlands
| Facility | $626.00 | $870.02 | $5,090.60 | |
Sanford Health Plan
| Professional | $447.44 | $641.17 | $754.29 | |
Sanford Health Plan
| Professional | 80 | $144.13 | $144.13 | $144.13 |
Sanford Health Plan
| Professional | AS | $144.13 | $144.13 | $144.13 |