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New York 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
$1.10 / $1.10 / $1.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $3.16 / $3.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.78 / $0.78 / $1.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.93 / $1.91
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $1.07 / $1.07
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $4.07
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $1.29 / $3.02
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $1.10 / $2.24
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $0.98 / $1.05
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.05 / $1.12
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $50,118.72 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $1.00 / $2.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1.05 / $1.12
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.05 / $1.15