go back

New Mexico 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–$81,2830%50%10th90th$1Professionalmedian $2 · 10th–90th $1–$40%20%10th90th$2$0.5$5.0$50.0$500.0$5.0K$50.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$3.89 / $3.89 / $3.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56,234.13 / $69,183.10 / $81,283.05
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.55 / $0.72 / $0.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.65 / $0.85 / $21.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $5.89 / $5.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $0.93 / $0.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $1.29 / $1.86