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Calorically Dense Pediatric Enteral Formula

Montana 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.

Professionalmedian $0 · 10th–90th $0$790%50%90th$0$0.5$1.0$2.0$5.0$10.0$20.0$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
$0.34
Median
$0.34
Typical High
$0.34
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.56
Median
$0.56
Typical High
$0.56
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$85.11