| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $15.81 | $36.81 | $77.00 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Christus
| Facility | $234.91 | $234.91 | $234.91 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $15.81 | $36.81 | $77.00 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Christus
| Facility | $234.91 | $234.91 | $234.91 |