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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 October 2026.

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

$1.20

Typical negotiated rate. In Virginia, October 2026.

Insurers have agreed to pay about $1.20 for this service. The price depends on where it is billed: about $1.26 from a physician practice, and about $0.63 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1.26$0.41 to $1.48
FacilityA hospital or hospital-owned outpatient department$0.63$0.41 to $2.24

How much rates vary

Facilitymedian $1 · 10th to 90th $0 to $10,233Professionalmedian $1 · 10th to 90th $0 to $2
$0.1$1$10$100$1K$10Kfacility $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
$0.41
Median
$0.41
Typical High
$1.48
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.41
Median
$1.48
Typical High
$1.48
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$0.46
Median
$1.02
Typical High
$1.48
CareFirst
Setting
Professional
Modifier
None
Typical Low
$1.26
Median
$1.26
Typical High
$1.26
Cigna
Setting
Facility
Modifier
None
Typical Low
$1.02
Median
$1.02
Typical High
$85.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$2.00
Median
$2.00
Typical High
$2.00
Medcost
Setting
Facility
Modifier
None
Typical Low
$0.43
Median
$1.48
Typical High
$2.24
Sentara
Setting
Facility
Modifier
None
Typical Low
$0.02
Median
$0.47
Typical High
$10,232.93
Sentara
Setting
Professional
Modifier
None
Typical Low
$0.02
Median
$0.47
Typical High
$10,232.93
United
Setting
Professional
Modifier
None
Typical Low
$1.17
Median
$1.17
Typical High
$1.17

Where Virginia 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.

Virginia· 18th 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.