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Maryland rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.87 / $0.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07