| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $7.87 | $15.95 | $42.32 | |
Molina
| Facility | $3,000.00 | $3,000.00 | $3,000.00 |
Drugs Requiring Specific Ident - Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $7.87 | $15.95 | $42.32 | |
Molina
| Facility | $3,000.00 | $3,000.00 | $3,000.00 |