| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $7.94 | $15.85 | $42.66 |
Pharmacy Extension of 025X-Drugs Requiring Detailed Coding
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $7.94 | $15.85 | $42.66 |