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Enteral Formula, Modular, Nutritionally Incomplete

Texas 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$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$0.83
Median
$0.85
Typical High
$0.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.50
Median
$0.83
Typical High
$0.95
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$79.43
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,548.13
Typical High
$4,786.30
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.78
Median
$0.78
Typical High
$0.89
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$0.66
Median
$0.66
Typical High
$0.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$0.79
Median
$0.93
Typical High
$17.38
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$0.49
Median
$0.89
Typical High
$0.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$6.17
Median
$6.17
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$0.79
Median
$0.98
Typical High
$19.05
Providence
Setting
Professional
Modifier
Global
Typical Low
$0.49
Median
$5.89
Typical High
$5.89
United
Setting
Facility
Modifier
Global
Typical Low
$0.93
Median
$0.93
Typical High
$0.93
United
Setting
Professional
Modifier
Global
Typical Low
$0.62
Median
$0.91
Typical High
$1.38
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$0.72
Median
$0.93
Typical High
$1.26