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Nebraska rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes 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
$1.13 / $3.24 / $3.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $2.84
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
$2.37 / $2.48 / $2.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.25 / $2.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $3.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $2.16
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.18
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.81 / $3.01 / $3.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.16