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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 October 2026.

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

$1.20

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $1.20 for this service. The price depends on where it is billed: about $1.12 from a physician practice, and about $1.86 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1.12$1.02 to $1.86
FacilityA hospital or hospital-owned outpatient department$1.86$1.86 to $3.63

How much rates vary

Facilitymedian $2 · 10th to 90th $1 to $603Professionalmedian $1 · 10th to 90th $1 to $2
$1$10$100$1Kfacility $2professional $1

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
$1.86
Median
$1.86
Typical High
$1.86
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.86
Median
$1.86
Typical High
$1.86
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$0.98
Median
$1.02
Typical High
$954.99
BCBS Minnesota
Setting
Professional
Modifier
None
Typical Low
$0.81
Median
$0.93
Typical High
$1.02
Cigna
Setting
Facility
Modifier
None
Typical Low
$2.34
Median
$3.55
Typical High
$10.00
Cigna
Setting
Professional
Modifier
None
Typical Low
$1.12
Median
$1.23
Typical High
$1.45
Health Partners
Setting
Facility
Modifier
None
Typical Low
$2.09
Median
$3.39
Typical High
$7.94
Health Partners
Setting
Professional
Modifier
None
Typical Low
$1.12
Median
$1.12
Typical High
$1.12
Medica
Setting
Facility
Modifier
None
Typical Low
$0.69
Median
$1.86
Typical High
$79.43
Medica
Setting
Professional
Modifier
None
Typical Low
$1.26
Median
$1.26
Typical High
$1.26
United
Setting
Professional
Modifier
None
Typical Low
$0.89
Median
$0.89
Typical High
$1.26

Where Minnesota 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.

Minnesota· 19th of 51

$1.20

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.