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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.45 / $0.55 / $0.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.60 / $0.63
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $0.87 / $1.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.91 / $1.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.92 / $5.92 / $5.92
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $1.83 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.87 / $1.59 / $2.42
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $1.22 / $1.22
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.88 / $1.22
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.53 / $1.63 / $5.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.96 / $1.51
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.88
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $0.88 / $0.88