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Missouri 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
$1.00 / $1.66 / $1.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $39.81 / $57.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.38 / $1.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.79 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.42 / $0.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.42 / $0.78