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Enteral Formula, Modular, Nutritionally Incomplete

Pennsylvania 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$60%20%40%10th90th$1Professionalmedian $1 · 10th–90th $0$40%20%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
$0.55
Median
$0.55
Typical High
$0.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.66
Typical High
$3.89
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1.86
Median
$1.86
Typical High
$1.86
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$0.55
Median
$0.55
Typical High
$0.66
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.62
Typical High
$0.83
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$4.07
Typical High
$7.08
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.91
Typical High
$0.91
United
Setting
Professional
Modifier
Global
Typical Low
$0.47
Median
$0.91
Typical High
$1.55