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Enteral Formula, Modular, Nutritionally Incomplete

Virginia 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%20%10th90th$1$0.1$1.0$10.0$100.0$1.0K

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
$0.52
Median
$0.52
Typical High
$0.91
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.55
Typical High
$0.91
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.89
Median
$0.89
Typical High
$0.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.72
Median
$0.72
Typical High
$1.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.51
Median
$1.51
Typical High
$6.92
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$0.79
Median
$1.07
Typical High
$1.66
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.45
Typical High
$1.45
Medcost
Setting
Facility
Modifier
Global
Typical Low
$0.56
Median
$0.91
Typical High
$1.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$0.47
Median
$0.47
Typical High
$0.68
Sentara
Setting
Facility
Modifier
Global
Typical Low
$0.65
Median
$0.95
Typical High
$4,897.79
Sentara
Setting
Professional
Modifier
Global
Typical Low
$0.62
Median
$0.95
Typical High
$4,897.79
United
Setting
Facility
Modifier
Global
Typical Low
$0.91
Median
$0.91
Typical High
$0.91
United
Setting
Professional
Modifier
Global
Typical Low
$0.48
Median
$0.87
Typical High
$1.45