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Maine 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
$0.55 / $0.55 / $0.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $0.92 / $1.06
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $1.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.55 / $0.55 / $0.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $1.37 / $1.62