| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.12 | $1.12 | $1.12 | |
Aetna
| Professional | $1.12 | $1.12 | $1.13 |
Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Aetna
| Facility | $1.12 | $1.12 | $1.12 | |
Aetna
| Professional | $1.12 | $1.12 | $1.13 |