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Colorado 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
$3.01 / $3.01 / $3.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $3.01 / $3.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $1.87 / $2.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $3.01 / $4.30
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.00 / $16.00 / $16.00