| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $164.60 | $164.60 | $164.60 | |
Aetna
| Professional | $157.00 | $164.60 | $207.39 | |
Cigna
| Professional | $150.75 | $152.26 | $188.44 | |
Medica
| Facility | $187.04 | $278.17 | $451.00 | |
Medica
| Professional | $172.37 | $172.37 | $172.37 | |
Midlands
| Professional | $176.06 | $176.06 | $176.06 | |
Sanford Health Plan
| Professional | $158.97 | $158.97 | $158.97 | |
United
| Professional | $172.37 | $172.37 | $177.07 | |
Wellmark
| Facility | $156.62 | $156.62 | $156.62 | |
Wellmark
| Professional | $156.62 | $156.62 | $156.62 |