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Arkansas rates for HCPCS B4162

Enternal Formula For Pediatrics Special Metabolic Needs For Inherited Disease

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.01 / $4.01 / $4.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $4.01 / $4.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179,999.82 / $489,999.51 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.93 / $7.85 / $7.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02