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Calorically Dense Pediatric Enteral Formula

Arizona rates for HCPCS B4160

Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Rates data updated July 2026.

Facilitymedian $3 · 10th–90th $1$70%5%10%10th90th$3Professionalmedian $1 · 10th–90th $0$10%20%40%10th90th$1$0.5$2.0$10.0$50.0

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

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.33
Median
$0.34
Typical High
$0.98
BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.79
Median
$3.39
Typical High
$6.61
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.71
Median
$0.79
Typical High
$5.75
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$0.42
Typical High
$0.42
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.07
Median
$1.38
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.33
Median
$0.33
Typical High
$0.33
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07