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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

Wisconsin 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?

$1.86

Typical negotiated rate. In Wisconsin, October 2026.

Insurers have agreed to pay about $1.86 for this service. The price depends on where it is billed: about $1.78 from a physician practice, and about $1.86 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$1.78$1.12 to $1.86
FacilityA hospital or hospital-owned outpatient department$1.86$1.86 to $3.09

How much rates vary

Facilitymedian $2 · 10th to 90th $0 to $5Professionalmedian $2 · 10th to 90th $1 to $4
$0.5$2$10$50facility $2professional $2

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
$1.86
Aetna
Setting
Professional
Modifier
None
Typical Low
$1.86
Median
$1.86
Typical High
$3.98
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1.78
Median
$1.78
Typical High
$1.78
Cigna
Setting
Facility
Modifier
None
Typical Low
$2.69
Median
$3.09
Typical High
$4.57
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$1.26
Typical High
$1.45
DeanCare
Setting
Facility
Modifier
None
Typical Low
$0.41
Median
$0.74
Typical High
$1.86
Medica
Setting
Facility
Modifier
None
Typical Low
$0.41
Median
$1.86
Typical High
$100.00
Medica
Setting
Professional
Modifier
None
Typical Low
$1.07
Median
$1.07
Typical High
$1.07
Prevea360
Setting
Facility
Modifier
None
Typical Low
$0.41
Median
$0.74
Typical High
$1.86
Quartz
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
United
Setting
Professional
Modifier
None
Typical Low
$1.07
Median
$1.07
Typical High
$1.07

Where Wisconsin 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.

Wisconsin· 7th of 51

$1.86

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.