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Washington 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

Facilitymedian $2 · 10th–90th $1–$60%20%40%10th90th$2Professionalmedian $1 · 10th–90th $1–$30%50%90th$1$1.0$2.0$5.0$10.0$20.0$50.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.74 / $1.74 / $1.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.29 / $2.51 / $75.86
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.29 / $2.29 / $2.29
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4.47 / $5.50 / $7.76
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.95 / $1.95 / $3.47