| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $100.00 | $125.00 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |
Noc For Parenteral Supplies
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Hally Health
| Professional | $100.00 | $125.00 | $345.40 | |
Hally Health
| Facility | $100.00 | $100.00 | $100.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 |