| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $151.36 | $151.36 | $151.36 | |
Oscar Health
| Facility | $281.84 | $1,071.52 | $3,019.95 | |
Wellmark
| Facility | $18,197.01 | $28,183.83 | $40,738.03 |
Pharmacy-Nongeneric Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Facility | $151.36 | $151.36 | $151.36 | |
Oscar Health
| Facility | $281.84 | $1,071.52 | $3,019.95 | |
Wellmark
| Facility | $18,197.01 | $28,183.83 | $40,738.03 |