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Calorically Dense Pediatric Enteral Formula

Idaho 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$20%10%20%10th90th$1Professionalmedian $0 · 10th–90th $0$10%50%90th$0$0.5$1.0$2.0

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
$0.34
Median
$0.34
Typical High
$0.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.81
Median
$1.00
Typical High
$1.95
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.95
Median
$0.95
Typical High
$0.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$0.42
Typical High
$0.42
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$0.34
Median
$0.34
Typical High
$0.49
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1.00
Median
$1.15
Typical High
$1.62