| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Moda Health
| Facility | $14.45 | $36.40 | $264.55 |
Inj Pantoprazole Sodium, Via
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Lucent Health
| Facility | $100.00 | $100.00 | $100.00 | |
Moda Health
| Facility | $14.45 | $36.40 | $264.55 |