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Enteral Formula, Inherited Disease of Metabolism

Pennsylvania rates for HCPCS B4157

Enteral formula, nutritionally complete, for special metabolic needs for inherited disease of metabolism, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Rates data updated October 2026.

How much does Enteral Formula, Inherited Disease of Metabolism cost?

$0.72

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $0.72 for this service. The price depends on where it is billed: about $0.72 from a physician practice, and about $0.72 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.72$0.72 to $4.47
FacilityA hospital or hospital-owned outpatient department$0.72$0.72 to $5,012

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $56,234Professionalmedian $1 · 10th to 90th $1 to $8
$1$10$100$1K$10K$100Kfacility $1professional $1

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$0.72
Median
$0.72
Typical High
$0.72
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.72
Median
$0.72
Typical High
$0.72
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.11
Median
$0.11
Typical High
$0.11
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.07
Median
$0.07
Typical High
$0.07
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$4.27
Median
$4.47
Typical High
$4.47
Cigna
Setting
Professional
Modifier
None
Typical Low
$8.13
Median
$8.13
Typical High
$8.13
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$0.72
Median
$0.72
Typical High
$0.72
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$0.72
Median
$0.72
Typical High
$0.72
Martin's Point
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.11
Median
$0.11
Typical High
$0.11
Martin's Point
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.07
Median
$0.07
Typical High
$0.07

Where Pennsylvania sits

The same service costs 158.5 times more in Montana than in Rhode Island. 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.

Pennsylvania· 50th of 51

$0.72

MT $79.43RI $0.50

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.