| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $12.00 | $12.00 | $57.47 | |
Medica
| Professional | $25.44 | $25.44 | $25.44 |
Drug Scr Qual 1 Drug Class Meth Ea Drug Class
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $12.00 | $12.00 | $57.47 | |
Medica
| Professional | $25.44 | $25.44 | $25.44 |