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North Dakota 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
$0.69 / $0.69 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $0.69 / $0.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.83 / $0.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $1.32 / $2.06
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.87 / $1.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.79 / $1.58