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South Carolina 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
$1.45 / $1.66 / $1.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $33.11 / $40.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.58 / $0.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.52 / $1.07
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.42 / $0.78