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Kentucky 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
$0.90 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.13 / $3.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.20 / $2.25
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.78 / $7.26 / $9.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $3.82 / $3.82