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Enteral Formula, Pediatric, Intact Nutrients

Tennessee rates for HCPCS B4158

Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Rates data updated October 2026.

How much rates vary

Facilitymedian $0 · 10th to 90th $0 to $0Professionalmedian $0 · 10th to 90th $0 to $1
$0.5$1facility $0professional $0

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
$0.41
Median
$0.41
Typical High
$0.41
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.41
Median
$0.41
Typical High
$0.41
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.06
Median
$0.06
Typical High
$0.06
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.04
Median
$0.04
Typical High
$0.04
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.52
Median
$0.52
Typical High
$0.52