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Iowa rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.82 / $0.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.12 / $1.41
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.80 / $1.12 / $2.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.02 / $1.62 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.51 / $1.35 / $2.22
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.35 / $1.41 / $1.71
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.33 / $1.58 / $2.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.50 / $0.85 / $1.74
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.23 / $1.23 / $1.23