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Oregon rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.41 / $2.10
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
$0.41 / $0.59 / $1.97
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.61 / $0.80 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $1.58 / $2.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $1.66 / $1.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00