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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

California 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 $1$10%20%40%10th90th$1Professionalmedian $0 · 10th–90th $0$30%50%10th90th$0$0.5$2.0$10.0$50.0$200.0

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
$0.40
Typical High
$0.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$1.48
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.83
Median
$0.93
Typical High
$1.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.74
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.91
Typical High
$39.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$3.02
Typical High
$398.11
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$1.70
Median
$1.70
Typical High
$1.70
Providence
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$0.56
Typical High
$1.86
Providence
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.87
Typical High
$0.87
United
Setting
Professional
Modifier
Global
Typical Low
$6.03
Median
$6.03
Typical High
$6.03