| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Florida Blue
| Facility | $55.17 | $76.95 | $161.24 | |
Molina
| Facility | $1,500.00 | $1,500.00 | $1,500.00 |
Drugs Requiring Specific Ident - Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Florida Blue
| Facility | $55.17 | $76.95 | $161.24 | |
Molina
| Facility | $1,500.00 | $1,500.00 | $1,500.00 |