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Ohio rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.85 / $1.85 / $4.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $1.85 / $1.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $1.21 / $1.73
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.79 / $59,499.41 / $61,249.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.88 / $0.88 / $0.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.67