| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $48.84 | $48.84 | $48.84 |
Medical/Surgical Supplies Extension of 027X-Supplies Incident to Radiology
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $48.84 | $48.84 | $48.84 |