go back

Enteral Formula, Modular, Nutritionally Incomplete

Maine 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$10%20%40%10th90th$1Professionalmedian $0 · 10th–90th $0$10%50%10th90th$0$0.5$1.0$2.0$5.0$10.0$20.0

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
$0.45
Median
$0.47
Typical High
$0.49
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$1.10
Typical High
$1.26
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.72
Median
$0.72
Typical High
$0.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$1.23
Typical High
$1.55
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$0.45
Median
$0.49
Typical High
$0.60
United
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$1.23
Typical High
$1.55