| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Wellmark
| Professional | $63.80 | $63.80 | $63.80 |
Unspecified Diagnostic Procedure, By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Wellmark
| Professional | $63.80 | $63.80 | $63.80 |