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Minnesota rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.02
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.47 / $3.55 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.82 / $3.55 / $3.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.37 / $7.59 / $18.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.29 / $2.63 / $2.88
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.75 / $7.24 / $14.13
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.24 / $3.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.95 / $3.24 / $79.43
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.14 / $2.14 / $2.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $2.14 / $2.40