go back

Indiana 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
$1.13 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $1.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.87 / $1.87 / $3.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.87 / $2.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.29 / $6.53 / $8.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.53 / $7.51 / $8.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.47 / $2.47 / $2.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.92