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New York 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%50%10th90th$1Professionalmedian $1 · 10th–90th $1–$20%20%10th90th$1$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.10 / $1.10 / $1.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.10 / $3.89 / $3.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.87 / $0.87 / $1.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.74 / $1.07 / $1.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.48 / $50,118.72 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.13 / $5.89 / $5.89
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $1.48 / $3.47
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $1.70 / $2.45
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $1.23 / $1.23
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.81 / $0.81 / $1.23
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.63 / $50,118.72 / $75,857.76
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.87 / $0.89 / $4.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.47 / $1.05 / $1.95
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $0.83 / $1.23
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.81 / $0.81 / $1.45