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Minnesota rates for HCPCS B4155

Enteral Formula Nutritionally Incomplete/Modular Nutients Includes Specific Calories = 1 Unit (Special Coverage Instructions A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.92 / $0.92 / $0.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $0.92 / $0.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $1.03 / $1.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $1.11 / $1.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.52 / $3.58 / $8.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.32 / $1.43
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.99 / $3.28 / $6.79
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.88 / $1.30 / $28.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.47 / $1.03 / $2.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $1.03 / $2.24