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
Current code18 hospitals with prices
What Washington hospitals publish for this code
Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.
| Hospital | Commercial insurance rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $1.16 – $5.36 | — | — |
| Deaconess Medical Center | $1.09 – $1.49 | — | — |
| Mary Bridge Children's Hospital | $1.04 – $2.97 | — | — |
| MultiCare Auburn Medical Center | $1.04 – $1.91 | — | — |
| MultiCare Covington Medical Center | $1.04 – $1.91 | — | — |
| MultiCare Good Samaritan Hospital | $1.04 – $1.91 | — | — |
| MultiCare Valley Hospital | $1.09 – $1.80 | — | — |
| Overlake Hospital Medical Center & Clinics | $1.80 – $2.27 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $1.80 | — | — |
| Providence Holy Family Hospital | $1.80 | — | — |
| Providence Regional Medical Center Everett | $1.80 | — | — |
| Swedish Edmonds Hospital | $1.80 | — | — |
| Swedish Issaquah | $1.80 | — | — |
| Swedish Medical Center | $1.80 | — | — |
| Swedish Medical Center / Cherry Hill | $1.80 | — | — |
| Tacoma General Allenmore Hospital | $1.04 – $1.91 | — | — |
| Virginia Mason Medical Center | $2.31 – $3.19 | — | — |
| Yakima Valley Memorial | $1.30 – $1.50 | — | — |
Medicare (traditional) reference
CMS publishes no national amount for this code.