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South Carolina 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
$0.96 / $0.96 / $0.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.88 / $0.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $1.23 / $1.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $1.11 / $2.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.83 / $1.55