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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

New York 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 $1 · 10th–90th $0$10%20%10th90th$1Professionalmedian $1 · 10th–90th $0$20%20%10th90th$1$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
$0.32
Median
$0.41
Typical High
$0.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.41
Typical High
$1.62
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.74
Typical High
$2.04
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.29
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.17
Cigna
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$10.23
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.45
Typical High
$2.45
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$0.85
Typical High
$1.12
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.02
Median
$1.12
Typical High
$1.12
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$1.82
Median
$50,118.72
Typical High
$75,857.76
United
Setting
Professional
Modifier
Global
Typical Low
$1.45
Median
$1.45
Typical High
$64.57
Univera
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$1.12
Typical High
$1.12
Univera
Setting
Professional
Modifier
Global
Typical Low
$1.02
Median
$1.12
Typical High
$1.12