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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Colorado 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 $2 · 10th–90th $2$20%50%10th$2Professionalmedian $2 · 10th–90th $0$20%50%10th$2$0.5$1.0$2.0

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
$1.86
Median
$1.86
Typical High
$1.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$1.86
Typical High
$1.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$0.43
Median
$1.86
Typical High
$2.63
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$0.40
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$3.98
Typical High
$3.98
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$1.58
Typical High
$1.66
Select Health
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$1.58
Typical High
$1.58
United
Setting
Facility
Modifier
Global
Typical Low
$1.66
Median
$1.66
Typical High
$1.86