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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

South Carolina 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 $0 · 10th–90th $0$00%50%90th$0Professionalmedian $0 · 10th–90th $0$00%50%$0$0.5$1.0

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
$0.41
Typical High
$0.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.41
Median
$0.41
Typical High
$0.41
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.38
Median
$1.38
Typical High
$1.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Medcost
Setting
Facility
Modifier
Global
Typical Low
$0.39
Median
$0.45
Typical High
$0.52
Medcost
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.40
Typical High
$0.40