| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $141.00 | $141.00 | $141.00 | |
Sanford Health Plan
| Professional | $51.20 | $51.20 | $51.20 |
Adenovirus Vaccine Type 4 Live Oral
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $141.00 | $141.00 | $141.00 | |
Sanford Health Plan
| Professional | $51.20 | $51.20 | $51.20 |