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Alaska 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

Facilitymedian $1 · 10th–90th $1–$210%50%10th90th$1Professionalmedian $2 · 10th–90th $1–$40%20%10th90th$2$1.0$2.0$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $2.45 / $3.39
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $1.17 / $20.89
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.17 / $1.23 / $3.98
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.23 / $1.23 / $1.23
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.17 / $1.17 / $1.17
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $1.00 / $20.89
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.41 / $2.95