| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.46 | $63.71 | $495.80 | |
Aetna
| Professional | $19.12 | $112.50 | $263.35 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.46 | $63.71 | $495.80 | |
Aetna
| Professional | $19.12 | $112.50 | $263.35 | |
Wellcare
| Facility | $100.00 | $100.00 | $100.00 |