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Arizona rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.82 / $5.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $7.26 / $12.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $1.34 / $2.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.84 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.87 / $2.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.86 / $2.89