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Iowa rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.24 / $3.24 / $3.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.13 / $3.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.25 / $2.80 / $2.81
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.81 / $5.04 / $150.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $100.00 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $2.62 / $3.18
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.01 / $3.01 / $3.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.62 / $3.01 / $3.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.52 / $1.52 / $2.70
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.65 / $2.65 / $2.65
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.65 / $2.65 / $2.65