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Enteral Formula, Modular, Nutritionally Incomplete

South Carolina 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%$1Professionalmedian $1 · 10th–90th $1$10%20%40%10th90th$1$0.5$1.0$2.0$5.0$10.0$20.0$50.0

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
$0.91
Median
$0.91
Typical High
$0.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.79
Median
$0.91
Typical High
$0.91
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.89
Median
$1.17
Typical High
$1.41
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$0.79
Median
$1.00
Typical High
$2.45
Medcost
Setting
Professional
Modifier
Global
Typical Low
$0.49
Median
$0.49
Typical High
$0.49
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
$0.91
Typical High
$1.35