| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.00 | $10.00 | $10.00 | |
Medcost
| Facility | $10.23 | $10.23 | $13.18 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |
Nonemergency transportation and bus, intra- or interstate carrier
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.00 | $10.00 | $10.00 | |
Medcost
| Facility | $10.23 | $10.23 | $13.18 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |