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Colorado 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
$0.60 / $0.60 / $0.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.60 / $0.85
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.00 / $2.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $1.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.60 / $1.12 / $1.53
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $1.27 / $1.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $1.22 / $1.75