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New Mexico 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
$0.84 / $0.88 / $2.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.65 / $0.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.64 / $0.88 / $11.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.63 / $0.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.09 / $1.67 / $2.08