| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $2.68 | $17.39 | $191.92 | |
Molina
| Facility | $37.27 | $482.24 | $13,339.98 | |
United
| Facility | $4,976.00 | $4,976.00 | $4,976.00 |
Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $2.68 | $17.39 | $191.92 | |
Molina
| Facility | $37.27 | $482.24 | $13,339.98 | |
United
| Facility | $4,976.00 | $4,976.00 | $4,976.00 |