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Illinois 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 $2 · 10th–90th $1–$70%10%10th90th$2Professionalmedian $1 · 10th–90th $1–$20%20%40%10th90th$1$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
$1.91 / $1.91 / $1.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.82 / $2.45
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.17 / $2.40 / $8.91
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.69 / $0.85 / $0.85
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.85 / $1.29 / $10.47
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.12
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $0.71 / $0.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $0.95 / $2.00