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Minnesota 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%20%10th90th$2Professionalmedian $1 · 10th–90th $1–$10%50%10th90th$1$0.5$2.0$10.0$50.0

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
$5.01 / $5.01 / $5.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.14 / $3.89 / $3.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.10 / $1.12 / $1.35
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $1.12 / $1.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.57 / $3.80 / $8.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.32 / $1.45
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.88 / $3.63 / $7.08
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.51
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.87 / $1.29 / $28.18
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.36 / $0.87 / $1.51
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.34 / $0.98 / $1.82