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California 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
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.45 / $1.62 / $1.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $2.24 / $2.63
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
$1.74 / $1.74 / $1.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.00 / $3.98 / $10.96
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
$5.50 / $5.50 / $5.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.15 / $1.58 / $3.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.74 / $1.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.77 / $9.77 / $9.77