| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.14 | $21.24 | $46.50 | |
Aetna
| Professional | $14.14 | $14.14 | $14.14 | |
Anthem BCBS
| Professional | $0.75 | $1.00 | $202.50 | |
United
| Professional | $50.00 | $50.00 | $50.00 |
Injection Tetracycline Up To 250 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.14 | $21.24 | $46.50 | |
Aetna
| Professional | $14.14 | $14.14 | $14.14 | |
Anthem BCBS
| Professional | $0.75 | $1.00 | $202.50 | |
United
| Professional | $50.00 | $50.00 | $50.00 |