| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.96 | $8.96 | $64.56 | |
Wellpoint
| Professional | $750.00 | $750.00 | $750.00 |
NOC drugs, other than inhalation drugs, administered through DME
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.96 | $8.96 | $64.56 | |
Wellpoint
| Professional | $750.00 | $750.00 | $750.00 |