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Kentucky 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
$0.48 / $0.54 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.64 / $0.92
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.89 / $0.89 / $0.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $1.85 / $1.85
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.89 / $1.60
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.84 / $0.89 / $1.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.41 / $1.41 / $1.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.08 / $5.08 / $34.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $0.90 / $1.44