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Pennsylvania 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 / $1.66 / $1.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $40.74 / $57.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.38
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
$1.45 / $1.66 / $1.66
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.51 / $0.60
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.51 / $12.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.47 / $0.78