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Virginia 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 / $2.68 / $2.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.87 / $1.87 / $1.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.04 / $2.04 / $2.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.00 / $9.00 / $16.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $2.68 / $3.24
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $2.60 / $9,929.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.60 / $9,929.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.02 / $2.02 / $2.02