| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.72 | $0.72 | $0.72 | |
Aetna
| Professional | $0.72 | $0.73 | $6.20 | |
Anthem BCBS
| Professional | $2.49 | $2.49 | $2.49 | |
United
| Professional | $50.00 | $50.00 | $50.00 |
Enternal Formula Nutritionally Complete For Special Metabolic Needs For
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.72 | $0.72 | $0.72 | |
Aetna
| Professional | $0.72 | $0.73 | $6.20 | |
Anthem BCBS
| Professional | $2.49 | $2.49 | $2.49 | |
United
| Professional | $50.00 | $50.00 | $50.00 |