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Enteral Formula, Modular, Nutritionally Incomplete

New Mexico 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$69,1830%50%10th90th$1Professionalmedian $1 · 10th–90th $1$40%50%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
$0.85
Median
$0.85
Typical High
$0.85
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.83
Median
$0.85
Typical High
$3.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$56,234.13
Median
$69,183.10
Typical High
$81,283.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.55
Median
$0.72
Typical High
$0.93
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.35
Typical High
$1.35
Providence
Setting
Facility
Modifier
Global
Typical Low
$0.65
Median
$0.85
Typical High
$21.38
Providence
Setting
Professional
Modifier
Global
Typical Low
$0.49
Median
$5.89
Typical High
$5.89
United
Setting
Facility
Modifier
Global
Typical Low
$0.93
Median
$0.93
Typical High
$0.93
United
Setting
Professional
Modifier
Global
Typical Low
$0.78
Median
$1.23
Typical High
$1.74