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Maryland rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $3.16 / $3.16
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.83 / $1.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.79 / $0.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.91 / $1.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07