| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.04 | $91.37 | $530.29 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Medica
| Facility | $4.80 | $65.72 | $82.66 | |
Midlands
| Facility | $0.90 | $0.90 | $1.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $65.04 | $91.37 | $530.29 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Medica
| Facility | $4.80 | $65.72 | $82.66 | |
Midlands
| Facility | $0.90 | $0.90 | $1.00 |