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Minnesota rates for HCPCS B4159

Enternal Formula For Pediatrics Nutritionally Complete Soy Based With Intact

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.01 / $1.03 / $1,174.65
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.82 / $1.03 / $1.03
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
$2.04 / $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
$0.69 / $1.85 / $80.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.26 / $1.26 / $1.26