go back

California rates for HCPCS B4160

Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.69 / $3.24 / $3.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.87 / $0.98 / $1.12
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.91 / $1.17
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.98
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.40 / $2.40 / $2.40
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.47 / $1.07
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.42 / $0.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.39 / $3.39 / $3.39