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New York 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 / $1.12 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.90 / $1.12 / $1.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $2.27 / $2.80
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.45
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.23 / $2.23 / $2.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.84 / $2.84 / $2.86
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.11 / $2.11 / $2.98
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.11 / $2.25 / $2.25
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $597.00 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $3.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.00 / $64.00 / $64.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.99 / $2.98 / $2.98
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.99 / $2.25 / $2.98