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Enteral Formula, Modular, Nutritionally Incomplete

Nebraska 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$890%50%90th$1Professionalmedian $1 · 10th–90th $1$40%20%10th90th$1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$0.91
Median
$0.91
Typical High
$1.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.68
Median
$0.91
Typical High
$3.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$1,548.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.81
Median
$0.85
Typical High
$0.85
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.23
Typical High
$1.41
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$1.58
Typical High
$89.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.37
Median
$0.79
Typical High
$2.09
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.41
Typical High
$1.41
United
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$0.91
Typical High
$0.91
United
Setting
Professional
Modifier
Global
Typical Low
$0.34
Median
$0.79
Typical High
$2.14