| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $12.00 | $12.00 | $124.17 | |
Medica
| Professional | $20.60 | $24.17 | $40.22 |
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 | $124.17 | |
Medica
| Professional | $20.60 | $24.17 | $40.22 |