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Virginia 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 / $0.86 / $0.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.11 / $1.11 / $1.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
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
$2.00 / $2.00 / $3.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.36 / $0.86 / $1.07
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.73 / $10,945.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.44 / $0.77 / $10,945.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $0.65 / $0.65