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Indiana rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $0.94 / $0.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.94 / $0.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.63 / $0.72 / $0.80
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $1.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.78
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.07 / $9.07 / $9.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $0.92 / $1.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $1.02 / $1.57