| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,374.87 | $2,374.87 | $2,374.87 | |
Aetna
| Professional | $95.00 | $2,374.87 | $2,374.87 | |
Medica
| Facility | $135.85 | $260.30 | $4,013.53 | |
Sanford Health Plan
| Professional | $3,371.10 | $3,371.10 | $3,371.10 |