go back

Enteral Formula, Pediatric, Intact Nutrients

Oregon 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.

Facilitymedian $1 · 10th–90th $1$10%50%$1Professionalmedian $0 · 10th–90th $0$10%50%10th90th$0$0.5$1.0$2.0$5.0$10.0$20.0$50.0

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
$0.40
Median
$0.41
Typical High
$0.41
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.52
Typical High
$0.52
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$0.59
Typical High
$1.95
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$0.79
Median
$0.79
Typical High
$0.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$0.41
Median
$1.38
Typical High
$3.98
Providence
Setting
Professional
Modifier
Global
Typical Low
$0.52
Median
$0.52
Typical High
$79.43
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.00