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California 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–$20%10%20%10th90th$1Professionalmedian $2 · 10th–90th $1–$40%10%20%10th90th$2$0.5$2.0$10.0$50.0$200.0

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
Facility
Modifier
Typical Low / Median / Typical High
$3.89 / $3.89 / $3.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $3.89 / $3.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.56 / $0.71 / $1.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.72 / $0.93 / $16.22
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.02 / $1.70 / $2.51
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.74 / $1.02 / $2.51
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.91 / $0.91 / $1.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.12 / $3.02
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.56 / $0.91 / $20.89
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.91 / $5.89 / $5.89
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $1.82 / $1.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.58 / $1.12 / $2.88