| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $821.00 | $821.00 | $821.00 | |
Sanford Health Plan
| Professional | $480.00 | $480.00 | $480.00 | |
United
| Facility | $821.00 | $821.00 | $821.00 |
Unlisted Maxillofacial Prosthetic Procedure
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $821.00 | $821.00 | $821.00 | |
Sanford Health Plan
| Professional | $480.00 | $480.00 | $480.00 | |
United
| Facility | $821.00 | $821.00 | $821.00 |