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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Alaska 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 October 2026.

How much does Pediatric Enteral Formula, Soy-Based, Intact Nutrients cost?

$0.41

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $0.41 for this service. The price depends on where it is billed: about $0.41 from a physician practice, and about $0.59 from a hospital or other facility.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.41$0.41 to $0.87
FacilityA hospital or hospital-owned outpatient department$0.59$0.41 to $1.86

How much rates vary

Facilitymedian $1 · 10th to 90th $0 to $3Professionalmedian $0 · 10th to 90th $0 to $60
$0.5$1$2$5$10$20$50facility $1professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). 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
None
Typical Low
$0.41
Median
$0.41
Typical High
$0.41
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.41
Median
$0.41
Typical High
$0.41
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Moda Health
Setting
Facility
Modifier
None
Typical Low
$0.41
Median
$0.41
Typical High
$0.59
Moda Health
Setting
Professional
Modifier
None
Typical Low
$0.41
Median
$0.41
Typical High
$60.26
Providence
Setting
Facility
Modifier
None
Typical Low
$1.86
Median
$1.86
Typical High
$2.63
Providence
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$60.26

Where Alaska sits

The same service costs 199.5 times more in Montana than in Utah. 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.

Alaska· 46th of 51

$0.41

MT $79.43UT $0.40

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.