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Pennsylvania rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.78 / $3.93 / $3.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.13
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.10 / $2.10 / $2.10