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Maryland rates for HCPCS B4155

Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.91 / $1.26
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $0.97 / $0.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.96 / $1.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.69 / $1.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.57 / $1.57 / $1.57