go back

Oregon 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
$0.93 / $1.46 / $5.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $2.85 / $3.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.46 / $2.09 / $3.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.46 / $1.50 / $1.69
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.54 / $1.55 / $2.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.59 / $2.88 / $4.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $2.48 / $2.90
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $2.45 / $5.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $2.52 / $4.90