| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $19.80 | $19.80 | $38.99 | |
Aetna
| Professional | $19.80 | $31.71 | $42.77 | |
Cigna
| Professional | $21.75 | $34.52 | $55.72 | |
Medica
| Facility | $24.28 | $42.68 | $75.88 | |
Medica
| Professional | $35.40 | $69.98 | $242.72 | |
Midlands
| Facility | $34.59 | $56.28 | $90.38 | |
Midlands
| Professional | $31.41 | $50.53 | $69.40 | |
Sanford Health Plan
| Professional | $32.44 | $46.62 | $72.26 | |
United
| Professional | $33.70 | $59.01 | $75.81 | |
Wellmark
| Professional | $27.60 | $33.50 | $65.80 |