| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $98.00 | $98.00 | $98.00 | |
Medica
| Facility | $11.15 | $42.75 | $1,245.88 | |
Midlands
| Facility | $0.90 | $0.90 | $1.00 |
NOC drugs, other than inhalation drugs, administered through DME
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $98.00 | $98.00 | $98.00 | |
Medica
| Facility | $11.15 | $42.75 | $1,245.88 | |
Midlands
| Facility | $0.90 | $0.90 | $1.00 |