go back

Colorado 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
Facility
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.71 / $1.71 / $1.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $1.27 / $1.67
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $1.09 / $1.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.29 / $1.92