go back

Enteral Formula, Modular, Nutritionally Incomplete

Illinois 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$50%20%10th90th$1Professionalmedian $1 · 10th–90th $1$10%20%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
$0.87
Median
$0.89
Typical High
$1.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.60
Median
$0.81
Typical High
$0.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.17
Median
$2.40
Typical High
$8.91
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.71
Median
$0.87
Typical High
$0.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$0.85
Median
$1.29
Typical High
$10.47
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
United
Setting
Facility
Modifier
Global
Typical Low
$0.71
Median
$0.87
Typical High
$0.87
United
Setting
Professional
Modifier
Global
Typical Low
$0.49
Median
$1.02
Typical High
$2.00