| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8.22 | $27.41 | $94.33 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Well Sense
| Professional | $2,500.00 | $3,000.00 | $3,750.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $8.22 | $27.41 | $94.33 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Well Sense
| Professional | $2,500.00 | $3,000.00 | $3,750.00 |