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Enteral Formula, Modular, Nutritionally Incomplete

California 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$20%10%20%10th90th$1Professionalmedian $1 · 10th–90th $0$40%10%10th90th$1$0.5$2.0$10.0$50.0$200.0

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
$0.40
Median
$0.46
Typical High
$3.89
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.60
Typical High
$3.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.56
Median
$0.71
Typical High
$1.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.74
Median
$0.93
Typical High
$4.27
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.74
Typical High
$2.51
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$0.74
Median
$1.02
Typical High
$2.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$0.91
Typical High
$1.00
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.12
Typical High
$3.02
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.35
Typical High
$1.35
Providence
Setting
Facility
Modifier
Global
Typical Low
$0.56
Median
$0.91
Typical High
$20.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$5.89
Typical High
$5.89
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
United
Setting
Professional
Modifier
Global
Typical Low
$0.58
Median
$1.12
Typical High
$2.82