| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.72 | $22.72 | $22.72 | |
Aetna
| Professional | $22.72 | $22.72 | $22.72 |
Drugs Or Medicaments Dispensed In The Office For Home Use
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $22.72 | $22.72 | $22.72 | |
Aetna
| Professional | $22.72 | $22.72 | $22.72 |