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North Dakota 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
$0.73 / $0.73 / $0.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.78 / $0.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $1.02 / $2.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.86 / $1.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.30 / $0.83 / $1.44