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Calorically Dense Pediatric Enteral Formula

Virginia 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 $0$10,0000%20%10th90th$1Professionalmedian $1 · 10th–90th $0$10%20%40%10th90th$1$0.5$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$0.34
Median
$0.85
Typical High
$0.85
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.33
Median
$0.34
Typical High
$0.85
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$0.49
Median
$0.49
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$0.42
Typical High
$0.42
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$3.02
Medcost
Setting
Facility
Modifier
Global
Typical Low
$0.36
Median
$0.91
Typical High
$1.07
Sentara
Setting
Facility
Modifier
Global
Typical Low
$0.45
Median
$4,073.80
Typical High
$10,964.78
Sentara
Setting
Professional
Modifier
Global
Typical Low
$0.45
Median
$4,073.80
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$0.65
Median
$0.65
Typical High
$0.65