| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $12.89 | $12.89 | $12.89 | |
Cigna
| Professional | $12.89 | $12.89 | $12.89 | |
United
| Professional | $12.43 | $12.58 | $18.64 |
Injection, fomepizole, 15 mg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $12.89 | $12.89 | $12.89 | |
Cigna
| Professional | $12.89 | $12.89 | $12.89 | |
United
| Professional | $12.43 | $12.58 | $18.64 |