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Oklahoma 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
$0.82 / $0.82 / $0.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.82 / $0.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $1.07 / $17.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.82 / $1.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.83 / $1.29