| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.13 | $1.13 | $1.13 | |
BCBS
| Professional | $2.00 | $2.00 | $2.00 | |
Providence
| Professional | $2.87 | $2.87 | $2.87 |
Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.13 | $1.13 | $1.13 | |
BCBS
| Professional | $2.00 | $2.00 | $2.00 | |
Providence
| Professional | $2.87 | $2.87 | $2.87 |