go back

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
Professional
Modifier
Low / Median / High Price
$1.45 / $1.66 / $3.98
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 / $0.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $1.95
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.47 / $0.85
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.24 / $0.41 / $0.58
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.23 / $0.33
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.54 / $3,548.13
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.54 / $3,548.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.39 / $0.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.50 / $0.79