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Georgia rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.58 / $1.87 / $1.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.75 / $2.84 / $5.53
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
$2.12 / $2.56 / $98.34