| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $0.26 | $2.47 | $12.14 |
Pharmacy Extension of 025X-Self-Administrable Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medical Mutual of Ohio
| Facility | $0.26 | $2.47 | $12.14 |