| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $2.24 | $12.02 | $83.18 | |
Midlands
| Facility | $39.81 | $39.81 | $39.81 | |
Oscar Health
| Facility | $616.60 | $724.44 | $724.44 |
Pharmacy Extension of 025X-Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $2.24 | $12.02 | $83.18 | |
Midlands
| Facility | $39.81 | $39.81 | $39.81 | |
Oscar Health
| Facility | $616.60 | $724.44 | $724.44 |