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Calorically Dense Pediatric Enteral Formula

Tennessee 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 October 2026.

How much rates vary

Facilitymedian $0 · 10th to 90th $0 to $0Professionalmedian $0 · 10th to 90th $0 to $0
$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
$0.34
Median
$0.34
Typical High
$0.34
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.34
Median
$0.34
Typical High
$0.51
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$0.05
Median
$0.05
Typical High
$0.05
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$0.03
Median
$0.03
Typical High
$0.03
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.42
Median
$0.42
Typical High
$0.42