| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.23 | $81.23 | $81.23 | |
Aetna
| Professional | $62.50 | $62.50 | $94.00 |
Compounded drug, not otherwise classified
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $75.23 | $81.23 | $81.23 | |
Aetna
| Professional | $62.50 | $62.50 | $94.00 |