| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $102.72 | $112.07 | $237.50 | |
Aetna
| Facility | 25 | $233.50 | $233.50 | $233.50 |
Medica
| Facility | $13.00 | $17.46 | $39.69 | |
Midlands
| Facility | $16.50 | $30.00 | $38.50 | |
Sanford Health Plan
| Professional | $16.39 | $21.99 | $34.22 |