| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.15 | $0.15 | $0.15 | |
Aetna
| Professional | $0.15 | $0.15 | $0.15 | |
Cigna
| Professional | $161.63 | $161.63 | $202.03 | |
United
| Professional | $0.28 | $0.72 | $0.72 |
Isoetharine Hcl Inhalation Solution Administered Through Dme Concentrated Form Per Milligram (Special Coverage Instructions Apply. See Mcm: 2100.5)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.15 | $0.15 | $0.15 | |
Aetna
| Professional | $0.15 | $0.15 | $0.15 | |
Cigna
| Professional | $161.63 | $161.63 | $202.03 | |
United
| Professional | $0.28 | $0.72 | $0.72 |