| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Christus
| Facility | $2.40 | $2.40 | $26.00 | |
Moda Health
| Facility | $0.24 | $1.96 | $11.94 |
Pharmacy Extension of 025X-Self-Administrable Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Christus
| Facility | $2.40 | $2.40 | $26.00 | |
Moda Health
| Facility | $0.24 | $1.96 | $11.94 |