Enteral Formula, Nutritionally Complete, Hydrolyzed Proteins

B4153 is the Healthcare Common Procedure Code System (HCPCS) code used to bill for this item.

Note: The estimates below are based on Medica Choice network contract rates. How were these costs calculated?

Cost Key:
Lower Cost Medium Cost Higher Cost
Facility     City/State Average Cost Range    
  ActivStyle Inc Minneapolis, MN $2.05 - $2.15
  Allina Home Oxygen & Medical Equipment Saint Paul, MN $3.50 - $6.60
  Apria Healthcare LLC Rice Lake, WI $2.05 - $2.15
  Fairview Specialty Services Pharmacy Minneapolis, MN $2.05 - $2.15
  Pediatric Home Services Roseville, MN $3.50 - $6.60
  Sanford Health Accessories LLC Fargo, ND $2.05 - $2.15