| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $4.09 | $4.09 | $4.09 | |
Molina
| Professional | $30.00 | $30.00 | $50.00 |
Unclassified drug or biological used for ESRD on dialysis
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $4.09 | $4.09 | $4.09 | |
Molina
| Professional | $30.00 | $30.00 | $50.00 |