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Connecticut rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.21 / $1.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.09 / $1.41 / $1.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.21 / $1.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $2.13 / $2.29