| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Anthem BCBS
| Facility | $1.71 | $1.71 | $1.71 | |
Sentara
| Facility | $15,512.00 | $16,033.00 | $17,378.00 |
Pharmacy Extension of 025X-Self-Administrable Drugs
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Anthem BCBS
| Facility | $1.71 | $1.71 | $1.71 | |
Sentara
| Facility | $15,512.00 | $16,033.00 | $17,378.00 |