| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Sanford Health Plan
| Professional | $104.96 | $104.96 | $104.96 |
Puraply, puraply antimic
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Sanford Health Plan
| Professional | $104.96 | $104.96 | $104.96 |