| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.73 | $0.73 | $0.73 | |
Aetna
| Professional | $0.73 | $0.73 | $0.73 | |
CareFirst
| Professional | $5.51 | $5.51 | $5.51 |
Enternal Formula Nutritionally Complete For Special Metabolic Needs For
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.73 | $0.73 | $0.73 | |
Aetna
| Professional | $0.73 | $0.73 | $0.73 | |
CareFirst
| Professional | $5.51 | $5.51 | $5.51 |