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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Minnesota 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 $3 · 10th–90th $1$6030%10%20%10th90th$3Professionalmedian $1 · 10th–90th $1$10%50%10th90th$1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$0.39
Median
$0.41
Typical High
$0.41
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.02
Typical High
$933.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.81
Median
$1.02
Typical High
$1.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$3.63
Typical High
$10.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.32
Typical High
$1.45
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$2.82
Median
$4.07
Typical High
$7.94
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.51
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.69
Median
$1.86
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.26
Median
$1.26
Typical High
$1.26
United
Setting
Professional
Modifier
Global
Typical Low
$0.89
Median
$1.26
Typical High
$2.00