| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.79 | $4.05 | $109.01 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
AmeriHealth
| Facility | $28.92 | $69.20 | $214.42 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.79 | $4.05 | $109.01 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
AmeriHealth
| Facility | $28.92 | $69.20 | $214.42 |