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Utah 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
$0.32 / $0.32 / $0.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.47
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.47 / $0.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.46 / $0.86