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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Ohio 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 Ohio, October 2026.

Insurers have agreed to pay about $1.20 for this service. Most negotiated rates run $1.20 to $1.29.

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.

How much rates vary

Facilitymedian $2 · 10th to 90th $2 to $5Professionalmedian $1 · 10th to 90th $1 to $2
$1$2$5facility $2professional $1

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. 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
$5.01
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.86
Median
$1.86
Typical High
$5.01
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1.20
Median
$1.20
Typical High
$1.51
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$0.52
Median
$0.71
Typical High
$1.20
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Medical Mutual of Ohio
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Molina
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$50.12
Typical High
$50.12
United
Setting
Professional
Modifier
None
Typical Low
$2.04
Median
$2.04
Typical High
$2.04

Where Ohio 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.

Ohio· 17th 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.