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California rates for HCPCS B4149

Enteral Formula Manufactured Blendarized Natural Foods With Intact Nutrients Includes Proteins Fats Carbohydrates Vitamins And Minerals May Include Fiber Administered Through An Enteralfeeding Tube 100 Calories=1 Unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.65 / $4.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.76 / $4.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $2.14 / $5.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.03 / $1.13 / $1.78
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.81 / $2.68 / $3.54
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.24 / $2.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.30 / $1.43
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.70 / $3.91
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.50 / $90.00 / $90.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.93 / $1.30 / $2.10
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $1.30 / $1.30
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.74 / $2.74 / $2.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $1.69 / $3.87