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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
$1.66 / $1.66 / $1.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.66 / $1.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.26 / $0.33 / $0.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.40 / $8.13
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.81 / $1.45
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.62 / $1.41
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
$0.39 / $0.39 / $0.43
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.58 / $1.32
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.55 / $1.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.39 / $2.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.39
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.85 / $0.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.60 / $1.29