go back

Arizona rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.21 / $0.21 / $1.32
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $2.14 / $3.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.34 / $0.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.48 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.54 / $0.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.50 / $0.81