| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $5.62 | $5.62 | $5.62 | |
United
| Professional | $5.62 | $5.62 | $5.62 |
Injection, droperidol and fentanyl citrate, up to 2 ml ampule
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $5.62 | $5.62 | $5.62 | |
United
| Professional | $5.62 | $5.62 | $5.62 |