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Pediatric Hydrolyzed or Amino Acid Enteral Formula

South Dakota 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?

$2.57

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $2.57 for this service. Most negotiated rates run $2.24 to $2.82.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $3 · 10th to 90th $2 to $5Professionalmedian $3 · 10th to 90th $1 to $3
$2$5facility $3professional $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. 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
Global
Typical Low
$2.82
Median
$3.24
Typical High
$3.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$3.02
Typical High
$3.02
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.24
Median
$2.24
Typical High
$2.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.62
Median
$3.24
Typical High
$8.32
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2.57
Median
$2.57
Typical High
$2.57
United
Setting
Professional
Modifier
Global
Typical Low
$2.88
Median
$2.88
Typical High
$2.88
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$2.63
Median
$2.63
Typical High
$2.63

Where South Dakota 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.

South Dakota· 11th of 51

$2.57

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.