| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.93 | $97.93 | $97.93 | |
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $1.00 | $1.00 | $1,245.88 | |
Midlands
| Facility | $0.90 | $1.00 | $1.00 |
NOC drugs, other than inhalation drugs, administered through DME
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $97.93 | $97.93 | $97.93 | |
Hally Health
| Professional | $150.00 | $150.00 | $150.00 | |
Medica
| Facility | $1.00 | $1.00 | $1,245.88 | |
Midlands
| Facility | $0.90 | $1.00 | $1.00 |