| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.14 | $5.14 | $5.14 | |
Cigna
| Professional | $24.91 | $24.91 | $24.91 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |
Bicarbonate conc pow per pac
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $5.14 | $5.14 | $5.14 | |
Cigna
| Professional | $24.91 | $24.91 | $24.91 | |
Molina
| Professional | $17.00 | $21.25 | $50.00 |