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Louisiana 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 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $2.04 / $3.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.20 / $1.20 / $1.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.32 / $1.45 / $1.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74