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Alaska rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52