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Virginia 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
$0.50 / $0.50 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.59 / $0.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.12 / $2.12 / $2.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.90 / $1.82
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $0.98 / $1.19
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.47 / $0.67
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $1.00 / $4,845.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.91 / $4,845.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.83 / $1.70