| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.43 | $3.43 | $3.43 | |
Aetna
| Professional | $3.43 | $3.43 | $3.43 | |
Cigna
| Professional | $3.44 | $3.44 | $3.44 | |
United
| Professional | $4.13 | $4.13 | $4.13 |
Injection Tolazoline Hcl Up To 25 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $3.43 | $3.43 | $3.43 | |
Aetna
| Professional | $3.43 | $3.43 | $3.43 | |
Cigna
| Professional | $3.44 | $3.44 | $3.44 | |
United
| Professional | $4.13 | $4.13 | $4.13 |