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Ohio rates for RC 0250

Pharmacy

Insurance Carrier
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.86 / $7.27 / $25.76
Molina
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.75 / $1,016.52 / $17,206.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,069.00 / $5,069.00 / $5,069.00