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Oklahoma 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%20%10th90th$1Professionalmedian $1 · 10th–90th $0–$10%50%10th90th$1$0.5$2.0$10.0$50.0

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
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.85 / $0.85 / $0.85
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $1.15 / $16.98
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.81 / $1.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.76 / $0.89 / $0.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.31 / $0.83 / $1.20