| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |
Free-Standing Clinic - Visit by RHC/FQHC practitioner to a member in a SNF (not in a covered Part A stay) or NF or ICF MR or other residential facility
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $150.00 | $150.00 | $150.00 | |
Wellmark
| Facility | $18,170.00 | $28,440.00 | $40,290.00 |