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Ohio 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–$10%20%10th90th$1Professionalmedian $1 · 10th–90th $1–$20%10%10th90th$1$0.5$1.0$2.0$5.0$10.0$20.0

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
$7.08 / $10.96 / $10.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.14 / $6.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.85 / $0.91 / $1.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.62 / $0.78 / $1.45
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.87 / $0.87 / $0.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.83 / $5.89 / $5.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.10 / $1.66 / $28.84
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.07 / $1.23 / $2.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.71 / $0.71 / $0.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.91 / $1.55