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Arizona rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes 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
$1.00 / $1.00 / $3.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.82 / $2.95
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $5.62 / $10.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.09 / $4.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.09 / $4.27 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24