| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.14 | $14.14 | $14.14 | |
Aetna
| Professional | $14.14 | $14.14 | $14.14 | |
CareFirst
| Professional | $19.47 | $19.47 | $19.47 |
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 | $14.14 | $14.14 | |
Aetna
| Professional | $14.14 | $14.14 | $14.14 | |
CareFirst
| Professional | $19.47 | $19.47 | $19.47 |