| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |
All Inclusive Ancillary - General Classification
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |