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Arizona 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 $3 · 10th–90th $1–$70%10%10th90th$3Professionalmedian $2 · 10th–90th $1–$40%20%10th90th$2$0.5$2.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $3.89 / $3.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.91 / $3.80 / $7.08
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.63 / $0.83 / $6.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.56 / $0.91 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.68 / $1.00 / $1.51
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.76 / $0.76 / $0.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.47 / $0.95 / $1.51