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Enteral Formula, Modular, Nutritionally Incomplete

Alaska 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

Rates data updated July 2026.

Facilitymedian $1 · 10th–90th $1$210%50%10th90th$1Professionalmedian $1 · 10th–90th $1$40%20%40%10th90th$1$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.71
Median
$0.71
Typical High
$3.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$0.71
Median
$1.17
Typical High
$20.89
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$1.23
Typical High
$3.98
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.23
Median
$1.23
Typical High
$1.23
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.17
Providence
Setting
Facility
Modifier
Global
Typical Low
$0.71
Median
$1.00
Typical High
$20.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$60.26
Typical High
$60.26
United
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.41
Typical High
$2.95