| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $1.86 | $7.24 | $25.70 | |
Molina
| Facility | $46.77 | $363.08 | $3,715.35 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $1.86 | $7.24 | $25.70 | |
Molina
| Facility | $46.77 | $363.08 | $3,715.35 |