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Alaska 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

Facilitymedian $0 · 10th–90th $0–$10%20%40%90th$0Professionalmedian $1 · 10th–90th $1–$20%50%90th$1$0.5$1.0$2.0$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $0.52
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $0.41 / $0.59
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.78 / $60.26
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $0.41 / $0.59
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $60.26 / $60.26