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North Dakota 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 / $1.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $1.63 / $1.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.53 / $1.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1.85 / $4.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07