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Nebraska rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or 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
$1.02 / $1.02 / $1.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.47 / $3.47 / $3.47
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.26 / $87.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $794.33 / $1,548.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.78 / $0.79 / $0.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.35 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.58 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.83 / $2.69
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.35 / $1.58 / $3.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.85 / $0.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.83 / $2.69