go back

Indiana 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
$0.41 / $0.41 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.41 / $0.41
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.06 / $1.06 / $2.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $1.06 / $1.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.79 / $2.79 / $3.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.79 / $2.79 / $3.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.40 / $1.40 / $1.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.57 / $1.67