| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.41 | $0.41 | $0.41 | |
Aetna
| Professional | $0.40 | $0.41 | $0.41 | |
BCBS
| Professional | $0.78 | $0.78 | $0.78 | |
Cigna
| Professional | $0.88 | $0.88 | $1.06 |
Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.41 | $0.41 | $0.41 | |
Aetna
| Professional | $0.40 | $0.41 | $0.41 | |
BCBS
| Professional | $0.78 | $0.78 | $0.78 | |
Cigna
| Professional | $0.88 | $0.88 | $1.06 |