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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 October 2026.

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

$1.12

Typical negotiated rate. In New York, October 2026.

Insurers have agreed to pay about $1.12 for this service. The price depends on where it is billed: about $1.15 from a physician practice, and about $1.12 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 9 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1.15$1.07 to $1.74
FacilityA hospital or hospital-owned outpatient department$1.12$1.12 to $1.12

How much rates vary

Facilitymedian $1 · 10th to 90th $1 to $1Professionalmedian $1 · 10th to 90th $1 to $2
$0.5$1$2$5facility $1professional $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
$0.32
Median
$0.40
Typical High
$0.41
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.40
Median
$0.40
Typical High
$0.41
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1.07
Median
$1.74
Typical High
$1.74
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$0.11
Median
$0.11
Typical High
$0.17
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$0.79
Median
$0.79
Typical High
$1.38
CDPHP
Setting
Professional
Modifier
None
Typical Low
$1.17
Median
$1.17
Typical High
$1.17
Cigna
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$10.23
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$1.45
Median
$1.45
Typical High
$1.95
Excellus BCBS
Setting
Facility
Modifier
None
Typical Low
$0.85
Median
$1.12
Typical High
$1.12
Excellus BCBS
Setting
Professional
Modifier
None
Typical Low
$0.85
Median
$1.12
Typical High
$1.12
MVP Health Care
Setting
Facility
Modifier
None
Typical Low
$1.82
Median
$1.82
Typical High
$1.82
United
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Univera
Setting
Facility
Modifier
None
Typical Low
$0.85
Median
$1.12
Typical High
$1.12
Univera
Setting
Professional
Modifier
None
Typical Low
$0.85
Median
$1.12
Typical High
$1.12

Where New York 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.

New York· 22nd of 51

$1.12

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.