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Michigan 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–$50%5%10%10th90th$2Professionalmedian $1 · 10th–90th $1–$30%20%10th90th$1$0.2$0.5$1.0$2.0$5.0$10.0

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
$2.00 / $2.00 / $2.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.78 / $2.00 / $2.14
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.10 / $2.57 / $4.90
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.85 / $0.89 / $0.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.51 / $1.66 / $7.76
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.87 / $2.69 / $3.63
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.71 / $0.71 / $5.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $0.87 / $0.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.47 / $0.93 / $1.38