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Enteral Formula, Pediatric, Intact Nutrients

Maine 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

Rates data updated July 2026.

Professionalmedian $1 · 10th–90th $0$10%10%20%10th90th$1$0.5$1.0

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
Setting
Professional
Modifier
Global
Typical Low
$0.32
Median
$0.40
Typical High
$1.41
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.52
Typical High
$0.52
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$0.32
Median
$1.41
Typical High
$1.74