| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8.50 | $8.50 | $8.50 | |
Aetna
| Professional | $8.50 | $8.50 | $8.50 | |
CareFirst
| Professional | $24.30 | $24.30 | $24.30 | |
Kaiser Permanente
| Professional | $6.76 | $6.76 | $21.38 |
Drugs/Medicaments Dispensed Office For Home Use
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8.50 | $8.50 | $8.50 | |
Aetna
| Professional | $8.50 | $8.50 | $8.50 | |
CareFirst
| Professional | $24.30 | $24.30 | $24.30 | |
Kaiser Permanente
| Professional | $6.76 | $6.76 | $21.38 |