| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.98 | $55.68 | $143.65 | |
Aetna
| Professional | $55.00 | $112.50 | $187.50 | |
Moda Health
| Facility | $60.56 | $60.56 | $60.56 | |
Molina
| Professional | $55.00 | $78.00 | $1,500.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $45.98 | $55.68 | $143.65 | |
Aetna
| Professional | $55.00 | $112.50 | $187.50 | |
Moda Health
| Facility | $60.56 | $60.56 | $60.56 | |
Molina
| Professional | $55.00 | $78.00 | $1,500.00 |