| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $35.72 | $35.72 | $35.72 |
Unclassified drug or biological used for ESRD on dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Professional | $40.00 | $40.00 | $50.00 | |
Wellpoint
| Professional | $35.72 | $35.72 | $35.72 |