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Arizona rates for HCPCS B4162

Enternal Formula For Pediatrics Special Metabolic Needs For Inherited Disease

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.11 / $2.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.77 / $10.87 / $18.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.90 / $2.77 / $5.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $80.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72