| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.81 | $83.14 | $657.60 | |
Aetna
| Professional | $62.50 | $112.50 | $187.50 | |
Anthem BCBS
| Professional | $191.25 | $225.00 | $250.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $12.81 | $83.14 | $657.60 | |
Aetna
| Professional | $62.50 | $112.50 | $187.50 | |
Anthem BCBS
| Professional | $191.25 | $225.00 | $250.00 |