| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $46.89 | $46.89 | $46.89 | |
Medica
| Facility | $58.83 | $103.46 | $346.88 | |
Midlands
| Facility | $107.88 | $147.77 | $333.11 | |
Sanford Health Plan
| Professional | $66.08 | $87.48 | $252.97 | |
United
| Facility | $821.00 | $821.00 | $821.00 |