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Enteral Formula, Special Metabolic Needs

Iowa rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Rates data updated July 2026.

Facilitymedian $1 · 10th–90th $1$10%50%10th90th$1Professionalmedian $1 · 10th–90th $1$10%10%20%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.02
Typical High
$1.02
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.56
Median
$0.83
Typical High
$1.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.35
Typical High
$1.41
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$0.79
Median
$1.12
Typical High
$2.75
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.71
Median
$1.62
Typical High
$89.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$1.45
Typical High
$2.24
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.58
Typical High
$1.70
United
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$0.85
Typical High
$0.85
United
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$1.26
Typical High
$2.24
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.26
Typical High
$1.26