| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $69.87 | $69.87 | $69.87 | |
Medica
| Facility | $87.44 | $118.36 | $286.14 | |
Midlands
| Facility | $127.76 | $180.28 | $1,429.65 | |
Sanford Health Plan
| Professional | $87.10 | $119.75 | $159.66 | |
United
| Facility | $1,643.00 | $1,643.00 | $1,643.00 |