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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Kentucky 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 $0 · 10th–90th $0$850%50%90th$0Professionalmedian $1 · 10th–90th $0$20%20%10th90th$1$0.5$5.0$50.0$500.0$5.0K$50.0K

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
$0.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$0.41
Typical High
$1.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.71
Median
$1.26
Typical High
$1.26
CareSource
Setting
Facility
Modifier
Global
Typical Low
$41,686.94
Median
$44,668.36
Typical High
$56,234.13
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
$10.23
Typical High
$10.23