| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.51 | $3.71 | $56.81 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |
Pharmacy - Drugs Incident to Radiology
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.51 | $3.71 | $56.81 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |