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Iowa rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.66 / $1.66 / $1.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.47 / $0.47
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.74 / $1.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.72 / $89.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.66 / $1.10
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $0.72 / $0.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.39 / $0.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.42 / $1.02
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56