| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $6.35 | $6.35 | $6.35 | |
Medcost
| Facility | $2.95 | $2.95 | $2.95 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Unspecified Oral Dosage Form, Fda Approved Prescription Antieme
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $64.00 | $64.00 | $64.00 | |
Cigna
| Professional | $6.35 | $6.35 | $6.35 | |
Medcost
| Facility | $2.95 | $2.95 | $2.95 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |