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Enteral Formula, Modular, Nutritionally Incomplete

West 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 $0 · 10th–90th $0$00%50%$0Professionalmedian $1 · 10th–90th $0$10%20%10th90th$1$0.5$1.0$2.0$5.0$10.0$20.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$0.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$0.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.51
Median
$1.51
Typical High
$1.51
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$39.81
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$0.60
Median
$0.85
Typical High
$1.41