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Montana 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–$20%20%40%10th90th$1Professionalmedian $2 · 10th–90th $1–$40%20%10th90th$2$0.5$1.0$2.0$5.0$10.0$20.0$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
Professional
Modifier
Typical Low / Median / Typical High
$2.14 / $3.89 / $3.89
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.07 / $1.07 / $1.07
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.17 / $1.17 / $1.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.17 / $1.17 / $1.17
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.95 / $1.70 / $1.74
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.95 / $1.70 / $1.74
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.17 / $1.17 / $1.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.17 / $79.43 / $85.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.02 / $1.29 / $1.51