| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $14.14 | $19.94 | $34.50 | |
Aetna
| Professional | $11.48 | $13.81 | $14.14 | |
Horizon BCBS
| Professional | $478.12 | $478.12 | $478.12 |
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 | $19.94 | $34.50 | |
Aetna
| Professional | $11.48 | $13.81 | $14.14 | |
Horizon BCBS
| Professional | $478.12 | $478.12 | $478.12 |