| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.65 | $82.17 | $791.31 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Medica
| Facility | $17.10 | $30.19 | $258.73 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $30.65 | $82.17 | $791.31 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 | |
Medica
| Facility | $17.10 | $30.19 | $258.73 |