| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.19 | $10.19 | $10.19 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |
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 | $10.19 | $10.19 | $10.19 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |