| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $546.29 | $1,234.14 | $1,234.14 | |
Cigna
| Professional | $546.29 | $546.29 | $546.29 | |
United
| Professional | $546.29 | $819.44 | $1,016.49 |
Injection Cidofovir 375 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $546.29 | $1,234.14 | $1,234.14 | |
Cigna
| Professional | $546.29 | $546.29 | $546.29 | |
United
| Professional | $546.29 | $819.44 | $1,016.49 |