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Nebraska rates for HCPCS B4164

Parenteral Nutrition Solution: Carbohydrates (Dextrose) 50% Or Less (500 Ml = 1 Unit) - Homemix (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130 4450)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.47 / $23.47 / $23.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.13 / $23.47 / $71.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.85 / $1,837.24 / $3,839.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.87 / $23.84 / $24.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.39 / $28.50 / $35.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.47 / $43.25 / $115.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $20.50 / $41.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.05 / $31.01 / $33.90
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.00 / $31.01 / $51.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9.39 / $20.50 / $45.51