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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Florida 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$20%50%10th90th$1Professionalmedian $0 · 10th–90th $0$10%20%40%10th90th$0$0.5$1.0$2.0$5.0$10.0$20.0$50.0

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
$0.39
Median
$1.48
Typical High
$1.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.41
Typical High
$1.48
AvMed
Setting
Facility
Modifier
Global
Typical Low
$1.91
Median
$1.91
Typical High
$1.91
AvMed
Setting
Professional
Modifier
Global
Typical Low
$1.86
Median
$1.86
Typical High
$1.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
United
Setting
Professional
Modifier
Global
Typical Low
$1.62
Median
$1.62
Typical High
$1.62
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.12