| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Florida Blue
| Facility | $54.95 | $77.62 | $162.18 | |
Molina
| Facility | $794.33 | $794.33 | $1,023.29 |
Pharmacy-Other Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Florida Blue
| Facility | $54.95 | $77.62 | $162.18 | |
Molina
| Facility | $794.33 | $794.33 | $1,023.29 |