| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.72 | $0.72 | $0.72 | |
Aetna
| Professional | $0.72 | $0.72 | $0.73 |
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 | $0.72 | $0.73 |