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Washington, DC rates for HCPCS B4155

Enteral formula, nutritionally incomplete/modular nutrients, includes specific nutrients, carbohydrates (e.g., glucose polymers), proteins/amino acids (e.g., glutamine, arginine), fat (e.g., medium chain triglycerides) or combination, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.91 / $0.91 / $0.91
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $0.97 / $0.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $0.87 / $1.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.68 / $2.13