| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2.19 | $50.12 | $58.88 | |
Cigna
| Professional | $23.99 | $114.82 | $114.82 | |
Highmark BCBS
| Facility | $213.80 | $213.80 | $213.80 | |
United
| Professional | $9.33 | $12.30 | $20.89 |
Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 1-3
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $2.19 | $50.12 | $58.88 | |
Cigna
| Professional | $23.99 | $114.82 | $114.82 | |
Highmark BCBS
| Facility | $213.80 | $213.80 | $213.80 | |
United
| Professional | $9.33 | $12.30 | $20.89 |