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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Hawaii 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.

Professionalmedian $2 · 10th–90th $2$20%50%$2$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
HMSA
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$1.95
Typical High
$1.95