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Nebraska rates for HCPCS B4160

Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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
$0.34 / $1.07 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.89
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
$0.75 / $0.75 / $0.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.98 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.83
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.95 / $1.20
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $0.95 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83