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Michigan 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 / $3.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $1.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $2.52 / $4.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.90 / $0.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.75 / $0.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.42 / $1.85
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $1.42 / $1.70