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Maine rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.53 / $0.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.39 / $0.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.72 / $0.90