| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,365.16 | $4,365.16 | $4,365.16 | |
Medica
| Facility | $812.83 | $812.83 | $812.83 | |
Sanford Health Plan
| Professional | $239.88 | $239.88 | $239.88 | |
United
| Facility | $812.83 | $812.83 | $812.83 |