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Michigan 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 $1–$50%5%10%10th90th$2Professionalmedian $1 · 10th–90th $1–$20%20%40%10th90th$1$1.0$2.0$5.0$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
Facility
Modifier
Typical Low / Median / Typical High
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.78
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.02 / $2.45 / $4.68
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.78 / $0.81 / $0.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $0.52
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.29 / $1.41 / $4.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.70 / $1.86 / $2.40
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $0.52