| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $1.21 | $1.21 | $1.21 | |
MVP Health Care
| Facility | $1.21 | $1.21 | $1.21 | |
MVP Health Care
| Professional | $26.00 | $26.00 | $26.00 | |
United
| Professional | $14.51 | $24.18 | $47.31 |
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 |
|---|---|---|---|---|---|
Cigna
| Facility | $1.21 | $1.21 | $1.21 | |
MVP Health Care
| Facility | $1.21 | $1.21 | $1.21 | |
MVP Health Care
| Professional | $26.00 | $26.00 | $26.00 | |
United
| Professional | $14.51 | $24.18 | $47.31 |