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West 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
$0.20 / $0.20 / $0.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.20 / $0.23 / $0.44
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.28 / $0.28 / $0.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $0.69 / $0.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $1.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.66 / $0.87