go back

Nebraska rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.57 / $0.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.44 / $1.32
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
$0.35 / $0.37 / $0.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.47 / $0.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.44 / $0.73 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.38 / $1.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.48 / $0.71 / $0.79
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.71 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.18 / $0.36 / $0.84