go back

Louisiana 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
$1.02 / $1.02 / $3.16
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $89.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.91 / $0.91
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.85 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.91 / $1.41