| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,750.00 | $2,750.00 | $2,750.00 | |
BCBS
| Facility | $55.17 | $76.95 | $161.24 |
Pharmacy - Non-Generic Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $2,750.00 | $2,750.00 | $2,750.00 | |
BCBS
| Facility | $55.17 | $76.95 | $161.24 |
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