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Enteral Formula, Modular, Nutritionally Incomplete

Wisconsin 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%50%90th$1Professionalmedian $1 · 10th–90th $1$20%20%40%10th90th$1$0.1$0.5$2.0$10.0$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
$0.69
Median
$0.69
Typical High
$0.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.68
Median
$0.69
Typical High
$0.91
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$1.45
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.81
Median
$0.81
Typical High
$0.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$3.16
Typical High
$5.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.45
Typical High
$5.89
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$0.69
Median
$0.85
Typical High
$1.23
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$0.54
Median
$0.54
Typical High
$0.54
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.69
Median
$0.85
Typical High
$89.13
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.47
Median
$1.23
Typical High
$2.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$0.95
Median
$64.57
Typical High
$89.13
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1.55
Median
$1.55
Typical High
$1.55
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$0.69
Median
$0.85
Typical High
$1.23
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$0.54
Median
$0.54
Typical High
$0.54
Quartz
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$1.38
Typical High
$3.02
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1.78
Median
$89.13
Typical High
$89.13
Quartz
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
Security Health
Setting
Facility
Modifier
Global
Typical Low
$0.98
Median
$0.98
Typical High
$0.98
Security Health
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
United
Setting
Facility
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
United
Setting
Professional
Modifier
Global
Typical Low
$0.34
Median
$1.10
Typical High
$2.82