go back

Washington, DC rates for HCPCS B4155

Enteral Formula Nutritionally Incomplete/Modular Nutients Includes Specific Calories = 1 Unit (Special Coverage Instructions A

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