| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Sanford Health Plan
| Facility | $950.00 | $950.00 | $950.00 |
Urinary Stones W Esw Lithotripsy W/O Cc/Mcc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Sanford Health Plan
| Facility | $950.00 | $950.00 | $950.00 |