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Georgia 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

Professionalmedian $1 · 10th–90th $1–$10%50%10th90th$1$0.0$0.1$0.5$2.0$10.0

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
Professional
Modifier
Typical Low / Median / Typical High
$1.02 / $1.07 / $1.07
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
$1.26 / $1.51 / $10.00