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Utah 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
$0.92 / $0.92 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $0.92 / $1.46
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.72 / $1.90 / $2.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.85 / $2.44