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Enteral Formula, Modular, Nutritionally Incomplete

Hawaii 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.

Professionalmedian $1 · 10th–90th $1$10%50%90th$1

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
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.32
HMSA
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.23
Typical High
$1.23
United
Setting
Professional
Modifier
Global
Typical Low
$1.32
Median
$1.32
Typical High
$1.48