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Arkansas rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $3.47 / $3.47
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $85.11 / $87.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218,776.16 / $524,807.46 / $954,992.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.91 / $1.91 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $1.20 / $1.62