go back

Pennsylvania 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
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.01 / $1.05 / $1.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.34
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42