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Maryland rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and 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
$1.45 / $1.45 / $1.45
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.41 / $0.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.42 / $0.79
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.51 / $0.51