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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$2.45 / $2.45 / $2.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.86 / $2.19
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.48 / $0.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $1.00 / $1.32