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Michigan 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
$0.94 / $0.94 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.94 / $0.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $2.29 / $4.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $0.89 / $0.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.86 / $1.80
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.86 / $0.96 / $1.23
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.94 / $1.25
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $0.98 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.21 / $1.68