| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $34.67 | $131.83 | $426.58 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |
Medical/Surgical Supplies and Devices-General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $34.67 | $131.83 | $426.58 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |