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Oregon rates for HCPCS B4155

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.81 / $2.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $2.14 / $2.54
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.80 / $1.15 / $1.88
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.87 / $0.99
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.98 / $6.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $2.04 / $5.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $2.04 / $5.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.92 / $1.44 / $3.73
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.97 / $1.43 / $2.38