| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $22.19 | $22.19 | $22.19 |
Midlands
| Facility | 26 | $76.67 | $76.67 | $76.67 |
Sanford Health Plan
| Professional | 26 | $27.41 | $36.88 | $42.05 |
Peritoneogram Rs&I
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $22.19 | $22.19 | $22.19 |
Midlands
| Facility | 26 | $76.67 | $76.67 | $76.67 |
Sanford Health Plan
| Professional | 26 | $27.41 | $36.88 | $42.05 |