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Maine 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
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.45 / $0.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.33 / $0.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.62 / $0.76
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.62 / $0.76