| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,877.00 | $4,877.00 | $4,877.00 | |
Medica
| Facility | $397.00 | $460.00 | $1,048.00 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $1,551.45 | |
United
| Facility | $397.00 | $465.00 | $1,048.00 | |
Wellmark
| Facility | $541.00 | $1,014.00 | $1,525.00 |