| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.04 | $54.24 | $70.18 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 |
NOC drugs, other than inhalation drugs, administered through DME
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.04 | $54.24 | $70.18 | |
Molina
| Professional | $60.00 | $60.00 | $60.00 |