| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $15.39 | $296.33 | $1,590.66 | |
United
| Facility | $2,000.00 | $2,000.00 | $2,800.00 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $15.39 | $296.33 | $1,590.66 | |
United
| Facility | $2,000.00 | $2,000.00 | $2,800.00 |