| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Professional | $10.72 | $15.14 | $36.31 |
Drug(s) or substance(s), definitive, qualitative or quantitative, not otherwise specified; 4-6
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Professional | $10.72 | $15.14 | $36.31 |