| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $93.33 | $112.20 | $186.21 | |
HMSA
| Professional | $1,995.26 | $2,454.71 | $2,884.03 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $93.33 | $112.20 | $186.21 | |
HMSA
| Professional | $1,995.26 | $2,454.71 | $2,884.03 |