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Rhode Island 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
$0.51 / $0.51 / $0.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1.78 / $2.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.64 / $1.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $1.00 / $1.33