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Nevada 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.85 / $0.85 / $0.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.91 / $2.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.62 / $0.72 / $1.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $35.97
Hometown Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $0.90 / $1.71
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $0.91 / $1.43