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Utah rates for HCPCS B4152

Enteral Formula Nutritionally Complete Calorically Dense (Equal To Or Greater Ough An Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 6

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.43 / $0.47 / $0.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.53 / $0.72