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New York 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 $1 · 10th–90th $1–$10%50%10th90th$1Professionalmedian $1 · 10th–90th $1–$20%20%40%10th90th$1$1.0$10.0$100.0$1.0K$10.0K

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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.10 / $1.35 / $1.78
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.20 / $1.20 / $1.32
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.20 / $1.20 / $1.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $50,118.72 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.52 / $0.52 / $7.94
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.58 / $1.58 / $2.69
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.74 / $0.74 / $1.29
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $1.45 / $1.45
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.58 / $50,118.72 / $75,857.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.58 / $1.58 / $64.57
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.74 / $1.29 / $1.29
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $1.45 / $1.45