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California 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 $1 · 10th–90th $1–$10%20%40%10th90th$1Professionalmedian $2 · 10th–90th $1–$400%20%10th90th$2$0.5$2.0$10.0$50.0$200.0

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.83 / $0.93 / $1.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.07 / $1.10 / $1.35
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $0.52
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $3.02 / $15.14
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.09 / $2.09 / $2.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $0.56 / $1.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.40 / $0.52 / $0.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.62 / $5.62 / $5.62