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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Nationwide rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Rates data updated July 2026.

Facilitymedian $1 · 10th–90th $0$80%20%10th90th$1Professionalmedian $0 · 10th–90th $0$20%50%90th$0$0.0$0.5$10.0$200.0$5.0K$100.0K

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
$0.40
Median
$0.41
Typical High
$2.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.41
Typical High
$1.86
BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.83
Median
$0.93
Typical High
$1.23
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.81
Median
$1.07
Typical High
$1.74
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$4.17
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$1.12
Typical High
$1.45
United
Setting
Facility
Modifier
Global
Typical Low
$0.89
Median
$1.38
Typical High
$1,258.93
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.45
Typical High
$3.47