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Missouri 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 / $3.24 / $3.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.87 / $2.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $2.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $80.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.70 / $2.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.70 / $2.75