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