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Florida 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
$1.12 / $2.00 / $2.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.75
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.48 / $2.34 / $3.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.11 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $14.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $2.82 / $2.82
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $1.86