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Texas 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
$1.17 / $1.17 / $1.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $100.00 / $100.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.85 / $1.85
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.15 / $1.85
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.88 / $0.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.38
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.54