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Idaho 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%20%10th90th$1Professionalmedian $1 · 10th–90th $1–$60%20%10th90th$1$0.5$1.0$2.0$5.0$10.0$20.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.45 / $2.45 / $2.45
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.98 / $1.26 / $2.14
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.71 / $0.71 / $1.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $1.15 / $23.99
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.95 / $1.00 / $2.45
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.26 / $1.51 / $2.24
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.71 / $0.71 / $1.00
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.34 / $1.07 / $1.58