| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.64 | $32.90 | $96.36 | |
Aetna
| Professional | $87.00 | $94.00 | $187.50 | |
Molina
| Professional | $45.00 | $45.00 | $60.00 |
Compounded Drug, Noc
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $7.64 | $32.90 | $96.36 | |
Aetna
| Professional | $87.00 | $94.00 | $187.50 | |
Molina
| Professional | $45.00 | $45.00 | $60.00 |