| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.40 | $48.36 | $210.64 | |
Aetna
| Professional | $112.50 | $112.50 | $187.50 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.40 | $48.36 | $210.64 | |
Aetna
| Professional | $112.50 | $112.50 | $187.50 |