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Virginia 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%10th90th$1Professionalmedian $1 · 10th–90th $1–$20%20%40%10th90th$1$0.1$1.0$10.0$100.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$1.20 / $1.82 / $1.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $0.89 / $0.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.72 / $0.72 / $1.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.48 / $1.48 / $6.92
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.79 / $1.07 / $1.66
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.45
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.56 / $0.91 / $1.82
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.47 / $0.47 / $0.68
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.65 / $0.95 / $4,897.79
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.62 / $0.95 / $4,897.79
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.72 / $0.91 / $0.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.48 / $0.93 / $1.45