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Virginia rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $6.48 / $6.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $6.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.49 / $2.49 / $2.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.60 / $9.60 / $9.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $8.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.00 / $10.00 / $12.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $4.90 / $6.87
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.13 / $9,929.00 / $10,945.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.13 / $9,929.00 / $10,945.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.66 / $4.66 / $4.66