go back

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 July 2026.

Facilitymedian $2 · 10th–90th $0$20%50%10th$2Professionalmedian $2 · 10th–90th $1$20%20%40%10th$2$0.5$1.0$2.0$5.0$10.0$20.0$50.0

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
$1.86
Typical High
$1.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$1.86
Typical High
$1.86
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.71
Median
$1.20
Typical High
$1.91
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
$0.87
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$50.12
Typical High
$50.12
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.66