| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $4.09 | $4.09 | $4.09 | |
Molina
| Facility | $18.16 | $874.44 | $17,026.28 | |
United
| Facility | $2,500.00 | $2,500.00 | $2,500.00 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $4.09 | $4.09 | $4.09 | |
Molina
| Facility | $18.16 | $874.44 | $17,026.28 | |
United
| Facility | $2,500.00 | $2,500.00 | $2,500.00 |