go back

Georgia 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
$1.51 / $1.51 / $1.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $64.57 / $89.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $2.51 / $3.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.72 / $2.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $12.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.85 / $1.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.85 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $1.32 / $2.04