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Minnesota rates for HCPCS B4153

Enteral Formula Nutritionally Complete Hydrolyzed Proteins (Amino Accis And Ing Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And Mcm: 2130

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.67 / $1.67 / $1.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.22 / $1.67 / $1.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.75 / $1.90 / $2.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.64 / $2.04 / $2.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.21 / $5.97 / $14.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.89 / $2.20 / $2.38
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.32 / $5.46 / $11.31
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.88 / $1.88 / $2.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.53 / $2.60 / $10.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.81 / $1.70 / $3.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.54 / $1.70 / $3.55