| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4,823.00 | $4,823.00 | $4,823.00 | |
Medica
| Facility | $500.00 | $1,111.48 | $1,650.50 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 | |
United
| Facility | $500.00 | $515.00 | $1,149.00 | |
Wellmark
| Facility | $541.00 | $1,014.00 | $1,525.00 |