| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.97 | $12.42 | $140.28 | |
United
| Facility | $2,500.00 | $2,500.00 | $2,500.00 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1.97 | $12.42 | $140.28 | |
United
| Facility | $2,500.00 | $2,500.00 | $2,500.00 |