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Utah 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%50%10th$1Professionalmedian $1 · 10th–90th $1–$10%20%10th90th$1$0.5$1.0$2.0$5.0

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
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.26 / $1.38 / $1.38
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.98 / $0.98 / $2.82
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $1.00 / $1.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.69 / $1.10 / $1.32