| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.95 | $12.59 | $141.25 | |
Oscar Health
| Facility | $114.82 | $131.83 | $131.83 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.95 | $12.59 | $141.25 | |
Oscar Health
| Facility | $114.82 | $131.83 | $131.83 |