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Enteral Formula, Modular, Nutritionally Incomplete

New York 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%50%10th90th$1Professionalmedian $1 · 10th–90th $1$20%20%40%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
$0.45
Median
$0.63
Typical High
$1.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.55
Median
$0.63
Typical High
$0.71
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$1.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.74
Median
$1.07
Typical High
$1.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.51
Median
$1.51
Typical High
$1.51
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$39.81
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$0.89
Median
$1.48
Typical High
$3.47
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$0.89
Median
$1.70
Typical High
$2.45
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.81
Median
$1.23
Typical High
$1.23
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.81
Median
$0.81
Typical High
$1.23
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$2.63
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.87
Typical High
$1.62
United
Setting
Facility
Modifier
Global
Typical Low
$0.89
Median
$0.89
Typical High
$0.89
United
Setting
Professional
Modifier
Global
Typical Low
$0.47
Median
$1.10
Typical High
$2.24
Univera
Setting
Facility
Modifier
Global
Typical Low
$0.81
Median
$0.83
Typical High
$1.23
Univera
Setting
Professional
Modifier
Global
Typical Low
$0.81
Median
$0.81
Typical High
$1.45