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Michigan 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 / $3.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $2.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.09 / $5.37 / $10.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.70 / $1.78 / $1.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $2.82 / $9.33
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $3.16 / $4.37
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74