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Nationwide rates for HCPCS B4158

Enteral formula, for pediatrics, nutritionally complete 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.78 / $2.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $0.93 / $1.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $1.10 / $1.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.69 / $4.37 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.52 / $1.12 / $1.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.45 / $3.02