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Illinois rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $1.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $1.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.60 / $2.69 / $7.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.97 / $3.07 / $150.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00