go back

Florida 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
$0.50 / $0.71 / $0.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.71 / $0.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.77 / $0.80 / $1.59
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $0.53 / $0.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.37 / $0.80 / $1.50
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.89