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Virginia 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
$0.23 / $0.23 / $0.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.28 / $0.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.41
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.44 / $0.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $0.41 / $0.57
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.27 / $0.49 / $3,551.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.49 / $3,551.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.47 / $0.79