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Washington 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 $1–$40%20%10th90th$1$0.5$1.0$2.0$5.0$10.0$20.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.39 / $3.89 / $3.89
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.26 / $1.51 / $3.02
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $0.78 / $0.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $5.89 / $5.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $0.89 / $1.07
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.85 / $1.35 / $1.82
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.87 / $0.87 / $0.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.26 / $1.51 / $3.24
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $0.78 / $0.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.74 / $0.74 / $0.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.83 / $1.29 / $2.51
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $0.78 / $1.38