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New Mexico 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $5.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.50 / $5.50 / $5.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.74 / $1.74