go back

Nebraska rates for HCPCS B4158

Enternal Formula For Pediatrics Nutritionally Complete With Intact Nutrients

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.79 / $1.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $1.42
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
$0.95 / $0.99 / $1.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $1.71 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $1.45
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.21 / $1.21 / $2.40
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.21 / $2.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.45 / $1.45 / $1.45