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Illinois 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
$1.63 / $1.63 / $3.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.41 / $1.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.36 / $5.00 / $18.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.47 / $1.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.47 / $2.06 / $19.48
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
$1.91 / $1.91 / $1.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.47 / $1.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.80 / $3.63