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Missouri 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
$0.84 / $1.02 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.84 / $0.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $0.87 / $3.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.70 / $1.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.80 / $1.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.76 / $1.62 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.91 / $1.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.91 / $1.83