| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.29 | $66.29 | $66.29 | |
Aetna
| Professional | $66.29 | $66.29 | $66.29 | |
Cigna
| Professional | $67.89 | $67.89 | $67.89 | |
United
| Professional | $66.56 | $66.56 | $66.56 |
Infusion Dextran 40 500 Ml (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $66.29 | $66.29 | $66.29 | |
Aetna
| Professional | $66.29 | $66.29 | $66.29 | |
Cigna
| Professional | $67.89 | $67.89 | $67.89 | |
United
| Professional | $66.56 | $66.56 | $66.56 |