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California 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
Facility
Modifier
Low / Median / High Price
$0.23 / $0.23 / $1.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.27 / $1.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.49 / $1.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.37 / $0.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.53 / $0.82 / $1.25
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.55 / $0.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.68 / $1.31
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $90.00 / $90.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.38 / $2.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.38 / $0.38
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.25 / $0.56 / $1.10