| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,808.65 | $4,218.35 | $4,218.35 | |
Cigna
| Professional | $1,808.65 | $1,808.65 | $1,808.65 | |
United
| Professional | $1,686.58 | $1,808.65 | $2,712.98 |
Injection Cytomegalovirus Immune Globulin Intravenous (Human) Per Vial (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1,808.65 | $4,218.35 | $4,218.35 | |
Cigna
| Professional | $1,808.65 | $1,808.65 | $1,808.65 | |
United
| Professional | $1,686.58 | $1,808.65 | $2,712.98 |