| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6.36 | $55.51 | $90.12 | |
Aetna
| Professional | $57.91 | $112.50 | $187.50 | |
Medica
| Facility | $10.44 | $22.59 | $100.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $6.36 | $55.51 | $90.12 | |
Aetna
| Professional | $57.91 | $112.50 | $187.50 | |
Medica
| Facility | $10.44 | $22.59 | $100.00 |