| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $196.53 | $196.53 | $196.53 | |
Medica
| Facility | $160.33 | $249.15 | $422.48 | |
Midlands
| Facility | $230.77 | $348.37 | $461.88 | |
Sanford Health Plan
| Professional | $182.17 | $266.70 | $357.74 | |
United
| Facility | $821.00 | $821.00 | $821.00 |