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Arizona rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.21 / $6.21 / $6.21
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.43 / $80.22 / $133.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.05 / $20.43 / $40.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $8.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.21 / $80.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72