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Missouri 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–$30%20%10th90th$1Professionalmedian $1 · 10th–90th $0–$20%20%10th90th$1$0.1$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
$1.82 / $1.91 / $1.91
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $2.14 / $3.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.87 / $0.87 / $3.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.54 / $0.72 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $1.74 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.76 / $1.45
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.72 / $0.72 / $0.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.78 / $1.45