go back

Alabama 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
$1.32 / $1.82 / $3.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.69 / $69.18 / $77.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.89 / $5.89 / $7.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $0.91 / $0.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.79 / $1.29