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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 October 2026.

How much does Enteral Formula, Modular, Nutritionally Incomplete cost?

$0.87

Typical negotiated rate. In Washington, October 2026.

Insurers have agreed to pay about $0.87 for this service. The price depends on where it is billed: about $0.87 from a physician practice, and about $1.23 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.87$0.87 to $1.74
FacilityA hospital or hospital-owned outpatient department$1.23$0.89 to $1.70

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $2Professionalmedian $1 · 10th to 90th $1 to $6
$1$2$5$10facility $1professional $1

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$0.81
Median
$0.81
Typical High
$0.81
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.81
Median
$0.81
Typical High
$0.81
Asuris Northwest Health
Setting
Facility
Modifier
None
Typical Low
$0.71
Median
$1.07
Typical High
$2.00
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$0.78
Median
$0.78
Typical High
$0.95
Cigna
Setting
Professional
Modifier
None
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$0.89
Median
$0.89
Typical High
$1.12
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$0.85
Median
$1.32
Typical High
$2.04
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$1.41
Median
$1.51
Typical High
$2.00
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$0.78
Median
$0.78
Typical High
$0.78
United
Setting
Professional
Modifier
None
Typical Low
$0.91
Median
$1.38
Typical High
$2.75
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$0.74
Median
$0.74
Typical High
$1.38
2 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.12
Median
$0.12
Typical High
$0.12
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.08
Median
$0.08
Typical High
$0.08

Where Washington sits

The same service costs 3.6 times more in Florida than in Alabama. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Washington· 32nd of 51

$0.87

FL $1.70AL $0.47

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.