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Montana 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 / $0.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.60 / $1.60