| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
ConnectiCare
| Facility | $54,999.45 | $54,999.45 | $54,999.45 |
Pharmacy Extension of 025X-Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
ConnectiCare
| Facility | $54,999.45 | $54,999.45 | $54,999.45 |