| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $117.22 | $117.22 | $117.22 | |
Midlands
| Professional | $113.25 | $113.25 | $113.25 | |
Wellmark
| Professional | $94.30 | $94.30 | $94.30 |
Unspecified Adjunctive Procedure By Report
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $117.22 | $117.22 | $117.22 | |
Midlands
| Professional | $113.25 | $113.25 | $113.25 | |
Wellmark
| Professional | $94.30 | $94.30 | $94.30 |