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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Arkansas 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 $398,107 · 10th–90th $1$933,2540%10%20%10th90th$398,107Professionalmedian $1 · 10th–90th $0$10%50%10th$1$0.5$5.0$50.0$500.0$5.0K$50.0K$500.0K

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
$1.48
Median
$1.48
Typical High
$1.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$1.48
Typical High
$1.48
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.32
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87