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Calorically Dense Pediatric Enteral Formula

Wisconsin 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 $2 · 10th–90th $0$1000%10%10th90th$2Professionalmedian $0 · 10th–90th $0$10%50%90th$0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.34
Median
$0.34
Typical High
$0.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.34
Median
$0.34
Typical High
$0.34
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.95
Median
$1.12
Typical High
$1.12
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.82
Median
$2.09
Typical High
$3.39
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$0.85
Typical High
$0.95
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$0.34
Median
$1.07
Typical High
$1.07
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.34
Median
$1.07
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.83
Median
$0.83
Typical High
$0.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$0.65
Median
$54.95
Typical High
$89.13
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$0.34
Median
$1.07
Typical High
$1.07
Quartz
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$100.00
Typical High
$100.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$0.42
Median
$0.42
Typical High
$0.42
Security Health
Setting
Facility
Modifier
Global
Typical Low
$2.14
Median
$2.14
Typical High
$2.14
United
Setting
Professional
Modifier
Global
Typical Low
$0.83
Median
$0.83
Typical High
$1.07