| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $55.17 | $76.95 | $161.24 | |
United
| Facility | $3,850.00 | $3,850.00 | $3,850.00 |
Pharmacy - Drugs Incident to Other Diagnostic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $55.17 | $76.95 | $161.24 | |
United
| Facility | $3,850.00 | $3,850.00 | $3,850.00 |
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