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South Carolina 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 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $3.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.68 / $2.68 / $2.68
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.25 / $1.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.12