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Pediatric Hydrolyzed or Amino Acid Enteral Formula

Hawaii rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Rates data updated July 2026.

How much rates vary

Professionalmedian $3 · 10th to 90th $3 to $3
professional $3

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
HMSA
Setting
Professional
Modifier
Global
Typical Low
$3.39
Median
$3.39
Typical High
$3.39