| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $86.35 | $86.35 | $86.35 | |
Aetna
| Professional | $86.35 | $86.35 | $86.35 | |
Cigna
| Professional | $88.43 | $88.43 | $88.43 | |
United
| Professional | $82.37 | $86.70 | $86.70 |
Injection Pralidoxime Chloride Up To 1 Gm (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $86.35 | $86.35 | $86.35 | |
Aetna
| Professional | $86.35 | $86.35 | $86.35 | |
Cigna
| Professional | $88.43 | $88.43 | $88.43 | |
United
| Professional | $82.37 | $86.70 | $86.70 |