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Nationwide 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
$0.73 / $0.78 / $0.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.59 / $0.78 / $0.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $0.92 / $1.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.72 / $1.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $3.16 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.95 / $1.56