| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $80.40 | $80.40 | $80.40 | |
Medica
| Facility | $86.24 | $135.88 | $174.00 | |
Midlands
| Facility | $105.19 | $133.99 | $190.76 | |
Sanford Health Plan
| Professional | $103.92 | $144.12 | $164.31 | |
United
| Facility | $821.00 | $821.00 | $821.00 |