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Georgia rates for HCPCS B4159

Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.06 / $1.06
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.57 / $1.62 / $3.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.57 / $98.34