| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.02 | $0.02 | $0.02 | |
Cigna
| Professional | $27.67 | $27.67 | $34.59 | |
Molina
| Professional | $55.00 | $55.00 | $78.00 |
Antidepressants Tricyclic Other Cyclicals 6/More
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.02 | $0.02 | $0.02 | |
Cigna
| Professional | $27.67 | $27.67 | $34.59 | |
Molina
| Professional | $55.00 | $55.00 | $78.00 |