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North Carolina 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
Facility
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.88 / $0.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.26 / $1.44 / $1.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $0.92 / $0.98
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $0.94 / $1.06
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.18 / $1.18 / $1.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $1.23 / $2.69
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $90.00