| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.64 | $34.10 | $136.94 | |
Aetna
| Professional | $62.50 | $85.00 | $129.00 | |
Molina
| Professional | $17.00 | $17.00 | $20.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $23.64 | $34.10 | $136.94 | |
Aetna
| Professional | $62.50 | $85.00 | $129.00 | |
Molina
| Professional | $17.00 | $17.00 | $20.00 |