| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $134.90 | $169.82 | $213.80 | |
Medica
| Facility | $125.89 | $134.90 | $204.17 | |
Medica
| Professional | $426.58 | $426.58 | $426.58 | |
Sanford Health Plan
| Professional | $97.72 | $104.71 | $128.82 |