| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $78.20 | $78.20 | $91.08 | |
Horizon BCBS
| Professional | $10.00 | $10.00 | $10.00 |
Adenovirus Vaccine Type 4 Live Oral
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $78.20 | $78.20 | $91.08 | |
Horizon BCBS
| Professional | $10.00 | $10.00 | $10.00 |