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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Massachusetts 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 October 2026.

How much does Pediatric Enteral Formula, Soy-Based, Intact Nutrients cost?

$0.55

Typical negotiated rate. In Massachusetts, October 2026.

Insurers have agreed to pay about $0.55 for this service. The price depends on where it is billed: about $0.40 from a physician practice, and about $2.14 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.40$0.40 to $0.46
FacilityA hospital or hospital-owned outpatient department$2.14$0.46 to $100

How much rates vary

Facilitymedian $2 · 10th to 90th $0 to $3,715Professionalmedian $0 · 10th to 90th $0 to $1
$1$10$100$1K$10Kfacility $2professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$0.40
Median
$0.40
Typical High
$0.40
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.40
Median
$0.40
Typical High
$0.40
AllWays Health Partners
Setting
Facility
Modifier
None
Typical Low
$0.46
Median
$0.46
Typical High
$1.35
AllWays Health Partners
Setting
Professional
Modifier
None
Typical Low
$0.35
Median
$0.46
Typical High
$0.48
BCBS Massachusetts
Setting
Facility
Modifier
None
Typical Low
$2.14
Median
$2.45
Typical High
$4.47
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$1.23
Fallon Health
Setting
Facility
Modifier
None
Typical Low
$60.26
Median
$100.00
Typical High
$8,511.38
Mass General Brigham
Setting
Facility
Modifier
None
Typical Low
$0.46
Median
$0.46
Typical High
$1.35
Mass General Brigham
Setting
Professional
Modifier
None
Typical Low
$0.35
Median
$0.46
Typical High
$0.48
Well Sense
Setting
Facility
Modifier
None
Typical Low
$2,511.89
Median
$3,388.44
Typical High
$4,897.79

Where Massachusetts sits

The same service costs 199.5 times more in Montana than in Utah. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Massachusetts· 40th of 51

$0.55

MT $79.43UT $0.40

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.