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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Virginia 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$10,0000%20%10th90th$1Professionalmedian $1 · 10th–90th $0$10%20%40%10th90th$1$0.0$0.2$2.0$20.0$200.0$2.0K

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
$0.41
Median
$1.48
Typical High
$1.48
Aetna
Setting
Professional
Modifier
Global
Typical Low
$0.40
Median
$0.41
Typical High
$1.48
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1.02
Median
$1.02
Typical High
$85.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$2.00
Median
$2.00
Typical High
$2.00
Medcost
Setting
Facility
Modifier
Global
Typical Low
$0.43
Median
$1.55
Typical High
$1.86
Sentara
Setting
Facility
Modifier
Global
Typical Low
$0.02
Median
$7,413.10
Typical High
$10,964.78
Sentara
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$7,413.10
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$1.17
Median
$1.17
Typical High
$1.17