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South Carolina rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based 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 $0 · 10th–90th $0–$10%20%40%10th90th$0Professionalmedian $1 · 10th–90th $1–$10%50%$1$0.5$1.0$2.0$5.0$10.0$20.0

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
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.38 / $1.38 / $1.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.87 / $0.87 / $0.87
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.39 / $0.45 / $0.52
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.40 / $0.40 / $0.40
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20