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Pediatric Enteral Formula, Soy-Based, Intact Nutrients

West 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 rates vary

Facilitymedian $85 · 10th to 90th $85 to $85Professionalmedian $1 · 10th to 90th $0 to $10
$0.5$1$2$5$10$20$50facility $85professional $1

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
Professional
Modifier
None
Typical Low
$0.41
Median
$0.41
Typical High
$0.41
Cigna
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.87
Median
$0.87
Typical High
$10.23