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Michigan 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
Facility
Modifier
Low / Median / High Price
$0.44 / $0.44 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.44 / $0.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $1.05 / $2.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.46 / $0.46
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.49 / $0.56
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.44 / $0.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $0.52 / $0.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.51 / $0.78