| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $9.86 | $51.80 | $98.87 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $9.86 | $51.80 | $98.87 | |
Aetna
| Professional | $94.00 | $112.50 | $187.50 |