| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $8.61 | $8.61 | $8.61 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |
Pharmacy - Drugs Incident to Other Diagnostic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $8.61 | $8.61 | $8.61 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |