| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $2.25 | $13,785.00 | $13,785.00 | |
Horizon BCBS
| Professional | $2.31 | $2.31 | $3.29 | |
United
| Professional | $1.90 | $2.24 | $7.28 |
Injection Mannitol 25% In 50 Ml (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Horizon BCBS
| Facility | $2.25 | $13,785.00 | $13,785.00 | |
Horizon BCBS
| Professional | $2.31 | $2.31 | $3.29 | |
United
| Professional | $1.90 | $2.24 | $7.28 |