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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
$1.35 / $1.82 / $1.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $2.45 / $3.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.74 / $1.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.78 / $1.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $3.24 / $8.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.41 / $5.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.69 / $0.87 / $0.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.98 / $1.62