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Enteral Formula, Modular, Nutritionally Incomplete

South Dakota 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 $2 · 10th–90th $1$20%20%40%10th90th$2Professionalmedian $1 · 10th–90th $1$10%20%10th90th$1$0.5$1.0$2.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.69
Median
$1.78
Typical High
$1.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$1.07
Typical High
$1.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.41
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.12
Median
$1.55
Typical High
$2.95
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.32
Median
$0.95
Typical High
$1.66
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1.23
Median
$1.23
Typical High
$1.23
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$1.02
Typical High
$2.14
United
Setting
Professional
Modifier
Global
Typical Low
$0.32
Median
$0.95
Typical High
$1.58
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12