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Idaho 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
$0.73 / $0.89 / $0.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $0.94 / $12.75
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.84 / $0.88
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.21 / $2.04
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $1.28 / $2.06