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Maine rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.36 / $1.62 / $1.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.14 / $1.21 / $1.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $2.29 / $2.61