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Pediatric Hydrolyzed or Amino Acid Enteral Formula

Pennsylvania 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 does Pediatric Hydrolyzed or Amino Acid Enteral Formula cost?

$1.12

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $1.12 for this service. The price depends on where it is billed: about $1.12 from a physician practice, and about $1.12 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1.12$1.12 to $1.12
FacilityA hospital or hospital-owned outpatient department$1.12$1.12 to $10.96

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $16Professionalmedian $1 · 10th to 90th $1 to $2
$1$10$100$1K$10Kfacility $1professional $1

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
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$2.29
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$3.80
Median
$3.89
Typical High
$3.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.74
Median
$1.74
Typical High
$1.74
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$5.25
Median
$10.96
Typical High
$19.05
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2.09
Median
$2.09
Typical High
$2.09

Where Pennsylvania sits

The same service costs 3.0 times more in Hawaii than in North Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 40th of 51

$1.12

HI $3.39NC $1.12

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.