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Enteral Formula, Modular, Nutritionally Incomplete

Ohio 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$10%50%10th90th$1$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.65
Median
$0.65
Typical High
$0.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.65
Median
$0.65
Typical High
$0.65
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$0.91
Typical High
$1.35
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.62
Median
$0.78
Typical High
$1.45
CareSource
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
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
$5.89
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$0.85
Median
$5.89
Typical High
$5.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.10
Median
$1.66
Typical High
$28.18
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.23
Typical High
$2.24
United
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
United
Setting
Professional
Modifier
Global
Typical Low
$0.31
Median
$0.98
Typical High
$1.55