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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 July 2026.

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

$0.41

Typical negotiated rate. In Wisconsin, July 2026.

Insurers have agreed to pay about $0.41 for this service. The price depends on where it is billed: about $0.41 from a physician practice, and about $2.69 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$0.41$0.41 to $0.87
FacilityA hospital or hospital-owned outpatient department$2.69$1.86 to $5.62

How much rates vary

Facilitymedian $3 · 10th to 90th $0 to $100Professionalmedian $0 · 10th to 90th $0 to $1
$0.5$2$10$50facility $3professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. 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
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
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$0.02
Median
$1.07
Typical High
$1.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$3.16
Typical High
$5.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$1.26
Typical High
$1.45
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$1.86
Typical High
$1.86
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$1.86
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$89.13
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$1.86
Typical High
$1.86
Quartz
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$100.00
Typical High
$100.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$0.87
Median
$0.87
Typical High
$0.87
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$2.00

Where Wisconsin sits

The same service costs 5.6 times more in Wyoming than in Vermont. 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· 45th of 51

$0.41

WY $2.24VT $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.