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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
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $40.74 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $1.17 / $2.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.44 / $0.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.49 / $2.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.71 / $0.98
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.39 / $0.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.54 / $0.78