| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $151.36 | $151.36 | $151.36 | |
Wellmark
| Facility | $18,197.01 | $28,183.83 | $40,738.03 |
Freestanding Clinic-Visit by RHC/FQHC Practitioner to Other Non-RHC/FQHC Site (e.g. Scene of Accident)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $151.36 | $151.36 | $151.36 | |
Wellmark
| Facility | $18,197.01 | $28,183.83 | $40,738.03 |