| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.73 | $0.73 | $1.28 | |
Aetna
| Professional | $0.73 | $0.73 | $0.73 | |
Cigna
| Professional | $8.16 | $8.16 | $8.16 | |
Lucent Health
| Facility | $80.00 | $100.00 | $100.00 |
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 | $1.28 | |
Aetna
| Professional | $0.73 | $0.73 | $0.73 | |
Cigna
| Professional | $8.16 | $8.16 | $8.16 | |
Lucent Health
| Facility | $80.00 | $100.00 | $100.00 |