| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $23.73 | $23.73 | $23.73 |
Midlands
| Facility | 26 | $76.95 | $76.95 | $76.95 |
Sanford Health Plan
| Professional | 26 | $29.60 | $39.15 | $44.64 |
Urography, infusion, drip technique and/or bolus technique; with nephrotomography
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | 26 | $23.73 | $23.73 | $23.73 |
Midlands
| Facility | 26 | $76.95 | $76.95 | $76.95 |
Sanford Health Plan
| Professional | 26 | $29.60 | $39.15 | $44.64 |