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Enteral Formula, Modular, Nutritionally Incomplete

Montana 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%20%40%10th90th$1Professionalmedian $1 · 10th–90th $1$40%10%20%10th90th$1$0.5$1.0$2.0$5.0$10.0$20.0$50.0

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
Professional
Modifier
Global
Typical Low
$0.85
Median
$0.85
Typical High
$3.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.17
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.17
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$0.95
Median
$1.70
Typical High
$1.74
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$0.95
Median
$1.70
Typical High
$1.74
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.17
Providence
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$79.43
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$1.02
Median
$1.29
Typical High
$1.51