| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,338.00 | $15,697.34 | $15,697.34 | |
Medica
| Facility | $821.00 | $821.00 | $821.00 | |
Sanford Health Plan
| Professional | $120.00 | $120.00 | $120.00 | |
United
| Facility | $821.00 | $821.00 | $821.00 |