| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $10.33 | $10.79 | $28.26 |
Pharmacy Extension of 025X-Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Molina
| Facility | $10.33 | $10.79 | $28.26 |