| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $16.64 | $16.64 | $23.30 | |
Aetna
| Professional | $16.64 | $16.64 | $16.64 | |
United
| Professional | $3.26 | $3.26 | $3.32 |
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 | $16.64 | $16.64 | $23.30 | |
Aetna
| Professional | $16.64 | $16.64 | $16.64 | |
United
| Professional | $3.26 | $3.26 | $3.32 |