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North Carolina 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
$0.84 / $0.84 / $0.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.84 / $0.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.98 / $1.11 / $1.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.90 / $1.06
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.92 / $0.92 / $0.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $1.02 / $2.44
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $90.00 / $90.00