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Virginia 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
$0.91 / $0.91 / $1.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $1.02 / $1.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.60
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.28 / $1.28 / $1.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.90 / $2.90 / $2.90
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
$1.21 / $1.60 / $3.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $1.56 / $2.93
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.93 / $0.93 / $1.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.68 / $8,061.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $1.64 / $8,061.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $1.61 / $2.66