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Illinois 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–$70%10%20%10th90th$2Professionalmedian $1 · 10th–90th $1–$20%50%90th$1$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
Facility
Modifier
Typical Low / Median / Typical High
$1.86 / $1.86 / $1.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $2.63 / $7.24
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.50 / $0.50 / $0.50
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $0.52
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.95 / $2.82 / $199.53
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00