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Mississippi 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 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.98 / $2.98 / $3.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $17.00 / $20.00