| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $31.81 | $50.00 | $50.00 | |
Medica
| Facility | $31.81 | $31.81 | $32.76 |
Non-Emergency Transportation And Bus Intra Or Inter State Carrier (Not Valid For Medicare)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $31.81 | $50.00 | $50.00 | |
Medica
| Facility | $31.81 | $31.81 | $32.76 |