| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Highmark BCBS
| Facility | $0.07 | $0.84 | $10.90 | |
MVP Health Care
| Facility | $1.25 | $1.25 | $1.25 |
Pharmacy Extension of 025X-Self-Administrable Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Highmark BCBS
| Facility | $0.07 | $0.84 | $10.90 | |
MVP Health Care
| Facility | $1.25 | $1.25 | $1.25 |