| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $11.40 | $28.35 | $5,000.00 | |
Cigna
| Facility | $4,734.76 | $4,734.76 | $4,734.76 | |
Cigna
| Professional | $3,025.44 | $4,734.76 | $5,918.45 | |
Sanford Health Plan
| Professional | $212.00 | $212.00 | $212.00 |