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Illinois rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $37.15 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.50 / $3.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.59 / $3.55
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
$0.51 / $0.51 / $0.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.58 / $1.02