| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $170.20 | $170.20 | $1,245.88 |
NOC drugs, other than inhalation drugs, administered through DME
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $170.20 | $170.20 | $1,245.88 |