| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $55.17 | $76.95 | $161.24 | |
BCBS
| Facility | $23.40 | $38.79 | $45.70 | |
BCBS
| Facility | $1,860.00 | $2,146.00 | $3,929.00 | |
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 | |
BCBS
| Facility | $23.40 | $38.79 | $45.70 | |
BCBS
| Facility | $1,860.00 | $2,146.00 | $3,929.00 | |
United
| Facility | $3,850.00 | $3,850.00 | $3,850.00 |