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Calorically Dense Pediatric Enteral Formula

Iowa 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 $1 · 10th–90th $1$10%50%10th$1Professionalmedian $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
Facility
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.34
Median
$0.34
Typical High
$1.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.76
Median
$0.93
Typical High
$0.95
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1.78
Median
$1.78
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.95
Median
$100.00
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.33
Median
$0.83
Typical High
$1.20
Midlands
Setting
Professional
Modifier
Global
Typical Low
$0.95
Median
$0.95
Typical High
$1.23
United
Setting
Facility
Modifier
Global
Typical Low
$0.49
Median
$0.49
Typical High
$0.49
United
Setting
Professional
Modifier
Global
Typical Low
$0.49
Median
$0.49
Typical High
$0.49
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.00