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Ohio rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or 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
$7.94 / $7.94 / $8.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $81.28 / $89.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.83 / $1.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.93 / $1.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.76 / $1.82 / $1.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.15 / $1.74 / $2.63
SummaCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.38 / $2.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.65 / $0.81 / $0.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $1.17 / $1.95