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Iowa 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 $2 · 10th–90th $2–$20%50%$2Professionalmedian $2 · 10th–90th $1–$20%50%10th90th$2$0.5$2.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.78 / $1.78 / $1.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.78 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.41
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.82 / $2.82 / $151.36
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.20 / $100.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.40 / $1.12 / $2.40
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.20 / $1.20 / $2.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.12
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00