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Michigan 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
$1.63 / $1.63 / $3.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.04 / $1.63 / $1.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.94 / $4.13 / $8.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.47 / $1.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.36 / $1.36 / $2.47
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.63 / $1.92 / $2.47
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.67 / $1.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.56 / $1.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.89 / $2.64