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Minnesota rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.96 / $0.96 / $0.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.96 / $0.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.05 / $1.13 / $1.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.98 / $1.23 / $1.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.68 / $2.39 / $5.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.13 / $1.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.33 / $2.18 / $4.53
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.12 / $1.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $1.18 / $14.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.98 / $2.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.94 / $2.29