| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $303.30 | $303.30 | $3,511.00 | |
Medica
| Facility | $4,500.00 | $4,500.00 | $4,500.00 | |
Sanford Health Plan
| Professional | $1,948.80 | $1,948.80 | $1,948.80 | |
United
| Facility | $4,500.00 | $4,500.00 | $4,500.00 |