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Iowa rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.90 / $4.90 / $4.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $0.73 / $4.90
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
$6.27 / $12.68 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $100.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.72 / $3.00 / $4.90
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.00 / $3.00 / $3.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.61 / $3.00 / $3.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.50 / $3.50 / $3.50
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.90 / $2.90 / $2.90
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.90 / $2.90 / $2.90