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Indiana 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
$3.98 / $3.98 / $3.98
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 / $0.40 / $40.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.39 / $0.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.37 / $0.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.31 / $0.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.44 / $0.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.31 / $0.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.47 / $0.72