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Colorado 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
$0.95 / $0.95 / $0.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.94 / $0.95 / $1.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.16 / $3.16 / $3.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $2.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $2.22 / $2.59
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $0.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.24 / $2.02 / $2.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $2.31 / $3.01