| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.40 | $0.40 | $0.40 | |
Aetna
| Professional | $0.40 | $0.41 | $1.47 | |
Anthem BCBS
| Professional | $1.06 | $1.06 | $1.06 | |
United
| Professional | $50.00 | $50.00 | $50.00 |
Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $0.40 | $0.40 | $0.40 | |
Aetna
| Professional | $0.40 | $0.41 | $1.47 | |
Anthem BCBS
| Professional | $1.06 | $1.06 | $1.06 | |
United
| Professional | $50.00 | $50.00 | $50.00 |