| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $238.99 | $238.99 | $403.67 | |
Molina
| Facility | $49.09 | $1,000.04 | $16,856.46 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $238.99 | $238.99 | $403.67 | |
Molina
| Facility | $49.09 | $1,000.04 | $16,856.46 |