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Minnesota 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 $3 · 10th–90th $3$6310%20%40%10th90th$3Professionalmedian $3 · 10th–90th $1$30%50%10th$3$1.0$5.0$20.0$100.0$500.0$2.0K

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
Facility
Modifier
Global
Typical Low
$7.08
Median
$7.08
Typical High
$7.08
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$2.00
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3.31
Median
$3.39
Typical High
$933.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$2.69
Median
$3.39
Typical High
$3.39
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2.69
Median
$3.80
Typical High
$8.91
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.32
Typical High
$1.45
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$2.88
Median
$3.63
Typical High
$7.08
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$1.12
Median
$1.12
Typical High
$1.51
Medica
Setting
Facility
Modifier
Global
Typical Low
$0.69
Median
$1.78
Typical High
$79.43
Medica
Setting
Professional
Modifier
Global
Typical Low
$1.58
Median
$1.58
Typical High
$1.58
United
Setting
Professional
Modifier
Global
Typical Low
$0.89
Median
$1.12
Typical High
$1.58