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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.60 / $2.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.57 / $0.83 / $1.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $1.12 / $1.55