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