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Kansas rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.79 / $1.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $1.81 / $2.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $1.79 / $1.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.71 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40