| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.95 | $5.95 | $5.95 | |
Aetna
| Professional | $5.95 | $9.38 | $9.38 | |
Medica
| Facility | $5.42 | $9.38 | $885.11 |
Drugs Or Medicaments Dispensed In The Office For Home Use
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.95 | $5.95 | $5.95 | |
Aetna
| Professional | $5.95 | $9.38 | $9.38 | |
Medica
| Facility | $5.42 | $9.38 | $885.11 |