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Arkansas rates for HCPCS B4155

Enteral Formula Nutritionally Incomplete/Modular Nutients Includes Specific Calories = 1 Unit (Special Coverage Instructions A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.71 / $0.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.71 / $0.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179,999.82 / $489,999.51 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.83 / $0.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.88 / $1.40