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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
$0.25 / $0.25 / $0.27
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 / $0.32 / $0.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.25 / $0.25 / $0.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.61 / $0.75