| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $443.43 | $443.43 | $443.43 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |
Medical/Surgical Supplies and Devices - Other Supplies/Devices
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $443.43 | $443.43 | $443.43 | |
Sanford Health Plan
| Facility | $100.00 | $100.00 | $100.00 |