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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Nebraska 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 $646 · 10th–90th $0$1,2590%10%10th90th$646Professionalmedian $0 · 10th–90th $0$20%50%90th$0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$0.41
Typical High
$2.24
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$0.41
Typical High
$1.62
BCBS
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$794.33
Typical High
$1,548.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.41
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$1.78
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$1.07
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07