| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
United
| Professional | $8.38 | $15.07 | $36.49 |
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 | $8.38 | $15.07 | $36.49 |