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Illinois rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.54 / $0.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.46 / $0.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $2.42 / $6.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.69 / $6.89
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.65 / $1.14