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Illinois rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $3.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.68
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.10 / $7.08 / $28.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.35 / $2.35 / $2.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.95 / $6.73 / $150.00
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00