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Pennsylvania 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

Facilitymedian $1 · 10th–90th $0–$57,5440%10%20%10th90th$1Professionalmedian $2 · 10th–90th $1–$30%20%40%10th90th$2$0.5$5.0$50.0$500.0$5.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $3.47 / $3.47
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.23 / $1.23 / $1.23
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $0.78 / $0.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $1.82 / $1.82
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.30 / $1.12 / $2.95
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.30 / $0.91 / $2.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.45 / $1.02 / $1.70