| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $0.10 | $0.61 | $2.36 |
Pharmacy Extension of 025X-Self-Administrable Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
AmeriHealth
| Facility | $0.10 | $0.61 | $2.36 |