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Oregon rates for HCPCS B4159

Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.41 / $1.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.59 / $2.04
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.80 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $1.60 / $2.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $1.81 / $1.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00