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Ohio 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
$3.01 / $3.01 / $12.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $3.01 / $3.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $2.25 / $3.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $5.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.83 / $1.83 / $2.92