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North Carolina 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.36 / $2.36 / $2.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.49
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.30
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $100.00 / $100.00