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Virginia 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 / $1.47 / $1.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $1.47
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.03 / $1.03 / $1.03
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
$2.00 / $2.00 / $2.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $1.47 / $1.85
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.02 / $0.63 / $10,945.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.63 / $10,945.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.18