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Illinois 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 / $3.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.20 / $1.82 / $4.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.24 / $7.41 / $28.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.34 / $2.34 / $2.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.98 / $6.76 / $199.53
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20