| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4.57 | $4.57 | $4.57 | |
Aetna
| Professional | $4.57 | $4.57 | $4.88 | |
Providence
| Facility | $4.57 | $4.88 | $5.57 |
Drugs Or Medicaments Dispensed In The Office For Home Use
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $4.57 | $4.57 | $4.57 | |
Aetna
| Professional | $4.57 | $4.57 | $4.88 | |
Providence
| Facility | $4.57 | $4.88 | $5.57 |