| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.57 | $0.57 | $3.28 | |
Aetna
| Professional | $0.57 | $0.73 | $6.20 | |
Cigna
| Professional | $8.16 | $8.16 | $8.16 | |
Horizon BCBS
| Professional | $11.53 | $13.57 | $13.57 |
Enternal Formula Nutritionally Complete For Special Metabolic Needs For
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.57 | $0.57 | $3.28 | |
Aetna
| Professional | $0.57 | $0.73 | $6.20 | |
Cigna
| Professional | $8.16 | $8.16 | $8.16 | |
Horizon BCBS
| Professional | $11.53 | $13.57 | $13.57 |