| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $71.09 | $71.09 | $71.09 | |
Providence
| Facility | $2.85 | $5.69 | $9.10 | |
Providence
| Professional | $5.69 | $5.69 | $5.69 |
Inj Pantoprazole Sodium, Via
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Moda Health
| Facility | $71.09 | $71.09 | $71.09 | |
Providence
| Facility | $2.85 | $5.69 | $9.10 | |
Providence
| Professional | $5.69 | $5.69 | $5.69 |