| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.13 | $8.55 | $55.29 | |
Aetna
| Professional | $55.00 | $282.80 | $282.80 | |
Highmark BCBS
| Facility | $53.58 | $53.58 | $53.58 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $5.13 | $8.55 | $55.29 | |
Aetna
| Professional | $55.00 | $282.80 | $282.80 | |
Highmark BCBS
| Facility | $53.58 | $53.58 | $53.58 |