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Colorado rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $1.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $1.85 / $1.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.85 / $2.65
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.00 / $4.00 / $4.00