| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $0.65 | $3.33 | $181.70 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |
Medical/Surgical Supplies and Devices - Non Sterile Supply
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $0.65 | $3.33 | $181.70 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |