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Montana 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
Professional
Modifier
Low / Median / High Price
$0.49 / $1.60 / $1.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.68 / $0.68 / $0.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.74 / $0.74 / $0.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.45 / $0.45 / $0.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.66 / $0.75 / $1.12