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Enteral Formula, Modular, Nutritionally Incomplete

Massachusetts 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 $2 · 10th–90th $1$40%20%10th90th$2Professionalmedian $1 · 10th–90th $0$20%20%10th90th$1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$0.47
Median
$0.47
Typical High
$0.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.47
Median
$0.51
Typical High
$2.45
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$0.95
Typical High
$89.13
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$0.91
Typical High
$1.58
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.70
Median
$1.70
Typical High
$3.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$8.13
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$8,511.38
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$0.93
Typical High
$1.58
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$0.95
Typical High
$89.13
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$0.91
Typical High
$1.58
United
Setting
Facility
Modifier
Global
Typical Low
$0.95
Median
$0.95
Typical High
$0.95
United
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$0.98
Typical High
$1.58