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Pennsylvania rates for HCPCS B4149

Enteral Formula Manufactured Blendarized Natural Foods With Intact Nutrients Includes Proteins Fats Carbohydrates Vitamins And Minerals May Include Fiber Administered Through An Enteralfeeding Tube 100 Calories=1 Unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $0.82 / $0.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.91 / $4.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $0.82 / $0.99
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.91 / $4.20
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.72 / $0.72
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.45
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.35 / $1.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.71 / $1.40 / $2.17