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South Dakota 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–$30%20%10th90th$2Professionalmedian $1 · 10th–90th $1–$10%20%10th90th$1$1.0$2.0$5.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.00 / $1.78 / $1.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.59 / $1.78 / $4.79
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.35 / $1.35 / $1.35
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.07 / $1.07 / $1.07