go back

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
Facility
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.28 / $1.32
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
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
Facility
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.32
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.28 / $1.32
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.51
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.47 / $0.78