go back

Tennessee 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
$0.84 / $0.84 / $1.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.84 / $0.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $90.00 / $90.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $1.22 / $2.29