| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.00 | $100.00 | $100.00 |
Injection Droperidol And Fentanyl Citrate Up To 2 Ml Ampule (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $100.00 | $100.00 | $100.00 |