| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $6.84 | $6.84 | $6.84 |
Unspecified Oral Dosage Form, Fda Approved Prescription Antieme
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Professional | $6.84 | $6.84 | $6.84 |