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Ohio 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
$0.28 / $0.28 / $4.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.42 / $0.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.37 / $0.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.62 / $0.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.52 / $0.77