| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.95 | $1.95 | $1.95 | |
Molina
| Facility | $3,000.00 | $3,000.00 | $3,000.00 | |
United
| Facility | $4,976.00 | $4,976.00 | $4,976.00 |
Pharmacy - Drugs Incident to Other Diagnostic Services
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.95 | $1.95 | $1.95 | |
Molina
| Facility | $3,000.00 | $3,000.00 | $3,000.00 | |
United
| Facility | $4,976.00 | $4,976.00 | $4,976.00 |