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New York 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
$0.32 / $0.40 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.40 / $0.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.06 / $1.32 / $1.76
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.17 / $1.17 / $1.29
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.17 / $1.17 / $1.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.46
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.85 / $1.11
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.11 / $1.11
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $2.35
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.11
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.11