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Oklahoma 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
$1.42 / $1.42 / $1.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.42 / $1.42 / $1.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.49 / $1.49 / $1.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.47 / $1.79 / $6.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.42 / $2.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.62 / $2.57