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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 July 2026.

Facilitymedian $2 · 10th–90th $0$50%20%40%10th90th$2Professionalmedian $0 · 10th–90th $0$20%50%90th$0$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
$0.40
Median
$0.40
Typical High
$0.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$1.62
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$0.37
Median
$1.05
Typical High
$100.00
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$0.37
Median
$0.46
Typical High
$0.46
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2.14
Median
$2.14
Typical High
$4.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$1.23
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$8,511.38
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$0.37
Median
$1.05
Typical High
$100.00
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$0.37
Median
$0.46
Typical High
$0.46