go back

Arizona 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
$1.00 / $3.47 / $3.47
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.05 / $85.11 / $87.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.17 / $3.24 / $5.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.74 / $1.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $1.02 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.20 / $1.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $1.17 / $1.70