| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $35.25 | $35.25 | $35.25 | |
BCBS
| Professional | $35.25 | $35.25 | $35.25 | |
Cigna
| Professional | $27.67 | $27.67 | $34.59 | |
Molina
| Professional | $17.00 | $20.00 | $40.00 |
Antidepressants Tricyclic Other Cyclicals 6/More
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $35.25 | $35.25 | $35.25 | |
BCBS
| Professional | $35.25 | $35.25 | $35.25 | |
Cigna
| Professional | $27.67 | $27.67 | $34.59 | |
Molina
| Professional | $17.00 | $20.00 | $40.00 |