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Oregon 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
$0.72 / $0.73 / $4.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $1.04 / $4.26
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $2.29 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.04 / $6.46 / $15.30
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $6.46 / $6.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00