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Georgia 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
$0.78 / $0.78 / $1.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.80 / $0.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $1.42 / $3.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.73 / $2.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $1.55 / $3.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $24.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.98 / $98.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $1.27 / $1.59