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California 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
Facility
Modifier
Low / Median / High Price
$0.80 / $0.80 / $5.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.93 / $5.07
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.10 / $2.00 / $5.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.25 / $1.37 / $2.31
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.15 / $3.25 / $4.29
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $1.86 / $2.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.54 / $1.54 / $1.69
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.85 / $2.04 / $4.72
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.98 / $90.00 / $90.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.14 / $1.54 / $7.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.54 / $2.47
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.31 / $3.31 / $3.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.79 / $4.43