| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.00 | $1.00 | $3.02 | |
BCBS
| Professional | $2.00 | $2.00 | $2.00 | |
Providence
| Professional | $60.26 | $79.43 | $85.11 |
Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Professional | $1.00 | $1.00 | $3.02 | |
BCBS
| Professional | $2.00 | $2.00 | $2.00 | |
Providence
| Professional | $60.26 | $79.43 | $85.11 |