| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $1,860.00 | $2,146.00 | $3,929.00 | |
Hally Health
| Facility | $100.00 | $120.00 | $345.40 |
Pharmacy - Other Pharmacy
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $1,860.00 | $2,146.00 | $3,929.00 | |
Hally Health
| Facility | $100.00 | $120.00 | $345.40 |