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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Illinois 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 $0$50%20%10th90th$2Professionalmedian $0 · 10th–90th $0$20%50%90th$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
$0.41
Median
$0.41
Typical High
$2.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$0.41
Typical High
$1.86
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$2.69
Typical High
$7.24
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.48
Median
$0.50
Typical High
$0.50
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1.95
Median
$2.63
Typical High
$199.53
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20