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Kansas 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
$1.02 / $1.02 / $1.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $64.57 / $89.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $1.45 / $1.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.00 / $10.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $1.23 / $1.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $1.26 / $1.70