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Florida 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
$0.39 / $1.47 / $1.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $1.47 / $1.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.63 / $1.63 / $1.63
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.06 / $1.13