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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

North Dakota 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$20%50%10th$2Professionalmedian $2 · 10th–90th $1$20%20%10th90th$2$0.5$1.0$2.0$5.0

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
$1.62
Typical High
$1.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$1.62
Typical High
$1.62
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.35
Median
$1.55
Typical High
$1.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.41
Medica
Setting
Facility
Modifier
Global
Typical Low
$1.62
Median
$1.62
Typical High
$4.90
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$2.00