go back

Nebraska 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 $603 · 10th–90th $1–$1,0720%10%10th90th$603Professionalmedian $2 · 10th–90th $0–$40%20%10th90th$2$0.5$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.82 / $1.82 / $1.82
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
$616.60 / $794.33 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.81 / $0.85 / $0.85
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.23 / $1.41
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.91 / $1.58 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.79 / $2.09
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.23 / $1.41 / $1.41
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $0.91 / $0.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.35 / $0.79 / $2.14