| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $10.19 | $10.19 | $31.81 | |
Wellmark
| Professional | $194.00 | $194.00 | $194.00 |
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 | $31.81 | |
Wellmark
| Professional | $194.00 | $194.00 | $194.00 |