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Iowa rates for HCPCS B4160

Enternal Formula For Pediatrics Nutritionally Complete Calorically Dense

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.07 / $1.07 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.34 / $0.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.75 / $0.94 / $1.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.79 / $2.48 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $100.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.83 / $1.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.95 / $0.95 / $0.95
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.95 / $1.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.49 / $0.49 / $0.49
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.00