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Pennsylvania 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
$0.56 / $0.56 / $0.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.62 / $2.85
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.77 / $0.77 / $0.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.62 / $2.85
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.92 / $0.92 / $1.12
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $0.92 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $1.00 / $1.68