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Minnesota rates for HCPCS B4159

Enteral formula, for pediatrics, nutritionally complete soy based with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $3 · 10th–90th $1–$6310%20%10th90th$3Professionalmedian $1 · 10th–90th $1–$10%50%10th90th$1$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3.02 / $3.02 / $3.02
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $1.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.02 / $1.02 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.81 / $1.02 / $1.02
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.69 / $3.80 / $8.91
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.32 / $1.45
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.88 / $3.63 / $7.08
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.12 / $1.51
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.69 / $1.86 / $79.43
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.26 / $1.26 / $1.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $1.26 / $2.00