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Maryland 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
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $2.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.29 / $2.29
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
$5.01 / $5.01 / $5.01
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.86 / $1.86 / $1.86