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Indiana 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
$1.29 / $1.29 / $7.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.16 / $3.16 / $3.16
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $64.57 / $87.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.71 / $0.79 / $1.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $0.79 / $1.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.02 / $1.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.12 / $9.12 / $9.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $1.00 / $1.58