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Michigan 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
$0.73 / $0.73 / $5.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $2.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.60 / $7.56 / $14.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.56 / $2.69 / $2.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $3.25 / $4.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $3.25 / $3.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00