| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $164.45 | $1,138.01 | $1,826.88 | |
Medica
| Facility | $821.00 | $1,465.40 | $1,465.40 | |
Sanford Health Plan
| Professional | $133.60 | $133.60 | $133.60 | |
United
| Facility | $821.00 | $821.00 | $821.00 |