| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.19 | $10.19 | $10.19 | |
BCBS
| Professional | $25.00 | $25.00 | $25.00 | |
Medica
| Facility | $10.19 | $10.19 | $10.19 |
Nonemergency transportation and bus, intra- or interstate carrier
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.19 | $10.19 | $10.19 | |
BCBS
| Professional | $25.00 | $25.00 | $25.00 | |
Medica
| Facility | $10.19 | $10.19 | $10.19 |