| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.05 | $12.05 | $12.05 | |
Aetna
| Professional | $12.05 | $12.05 | $12.05 | |
Cigna
| Professional | $14.52 | $14.52 | $14.52 | |
United
| Professional | $13.79 | $14.52 | $14.52 |
Infusion Dextran 75 500 Ml (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.05 | $12.05 | $12.05 | |
Aetna
| Professional | $12.05 | $12.05 | $12.05 | |
Cigna
| Professional | $14.52 | $14.52 | $14.52 | |
United
| Professional | $13.79 | $14.52 | $14.52 |