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Enteral Formula, Modular, Nutritionally Incomplete

Wyoming 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%100%$1Professionalmedian $2 · 10th–90th $2$20%50%10th$2$0.5$1.0$2.0$5.0

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
Professional
Modifier
Global
Typical Low
$0.89
Median
$0.89
Typical High
$0.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.51
Median
$1.78
Typical High
$1.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$5.89
Median
$5.89
Typical High
$5.89
United
Setting
Facility
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.00
United
Setting
Professional
Modifier
Global
Typical Low
$0.47
Median
$1.26
Typical High
$2.75