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North Dakota 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 / $1.13 / $2.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $2.84 / $2.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.94 / $3.03 / $3.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.27 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.84 / $3.24 / $8.52
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $1.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.38