go back

Pennsylvania 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
$0.94 / $0.94 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.04 / $5.07
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.37 / $1.37 / $1.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.94 / $0.94 / $984.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.09 / $5.07
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.56 / $1.56 / $1.76
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.56 / $1.56 / $1.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $1.67 / $2.64