| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |
Loa/Reserved
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |