| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13.00 | $98.46 | $560.02 | |
Aetna
| Professional | $50.00 | $51.00 | $102.00 | |
Medica
| Facility | $21.08 | $65.45 | $100.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $13.00 | $98.46 | $560.02 | |
Aetna
| Professional | $50.00 | $51.00 | $102.00 | |
Medica
| Facility | $21.08 | $65.45 | $100.00 |