| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $8.46 | $8.46 | $8.46 | |
United
| Facility | $5,069.00 | $5,069.00 | $5,069.00 |
Pharmacy - Drugs Incident to Other Diagnostic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $8.46 | $8.46 | $8.46 | |
United
| Facility | $5,069.00 | $5,069.00 | $5,069.00 |