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Utah rates for HCPCS B4153

Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $2 · 10th–90th $2–$30%50%10th90th$2Professionalmedian $1 · 10th–90th $1–$20%50%90th$1$1.0$2.0$5.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $2.45
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.66 / $1.82 / $2.51
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.55 / $1.55 / $4.90
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.26 / $1.58 / $1.58
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.20 / $2.00 / $2.45