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Arizona rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.46 / $2.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.18 / $4.65 / $7.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.74 / $1.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.51 / $1.19 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.18 / $1.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $1.17 / $1.71