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Nebraska 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
$0.54 / $0.85 / $0.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.54 / $1.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.59 / $801.77 / $1,675.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.45 / $0.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.47 / $0.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.54 / $0.89 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.47 / $1.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.56 / $0.88 / $0.98
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.88 / $1.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.22 / $0.47 / $1.11