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Enteral Formula, Modular, Nutritionally Incomplete

Washington 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$20%20%10th90th$1Professionalmedian $1 · 10th–90th $1$40%50%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
$0.81
Median
$0.81
Typical High
$0.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.55
Median
$0.81
Typical High
$3.89
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$1.20
Median
$1.51
Typical High
$2.82
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$0.78
Median
$0.78
Typical High
$0.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$0.89
Median
$0.89
Typical High
$1.07
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$1.35
Typical High
$1.82
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1.26
Median
$1.51
Typical High
$2.82
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$0.78
Median
$0.78
Typical High
$0.78
United
Setting
Facility
Modifier
Global
Typical Low
$0.74
Median
$0.91
Typical High
$0.91
United
Setting
Professional
Modifier
Global
Typical Low
$0.83
Median
$1.35
Typical High
$2.57
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$0.78
Median
$0.78
Typical High
$1.38