| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $46.77 | $46.77 | $457.09 | |
Molina
| Facility | $28.18 | $588.84 | $6,309.57 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $46.77 | $46.77 | $457.09 | |
Molina
| Facility | $28.18 | $588.84 | $6,309.57 |