| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $256.00 | $260.06 | $1,210.56 | |
Medica
| Facility | $7.38 | $7.38 | $7.38 |
Pharmacy Extension of 025X-Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Facility | $256.00 | $260.06 | $1,210.56 | |
Medica
| Facility | $7.38 | $7.38 | $7.38 |