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Georgia rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.46 / $0.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.46 / $0.47 / $0.57
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.75 / $1.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.39 / $1.12
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $0.74 / $1.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $2.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.52 / $98.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.75 / $1.12