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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $2.81 / $4.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.30 / $2.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.85 / $2.21