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New Jersey 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
$0.90 / $0.90 / $2.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.13 / $2.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.74 / $3.22 / $3.22