| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $203.47 | $203.47 | $203.47 | |
Medica
| Facility | $115.84 | $224.85 | $803.21 | |
Midlands
| Facility | $267.83 | $416.64 | $621.92 | |
Sanford Health Plan
| Professional | $190.11 | $264.25 | $504.36 | |
United
| Facility | $821.00 | $821.00 | $821.00 |