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Iowa rates for HCPCS B4161

Enteral formula, for pediatrics, hydrolyzed/amino acids and peptide chain proteins, includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.00 / $3.24 / $3.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $3.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.24 / $2.82 / $2.82
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.80 / $5.89 / $151.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3.02 / $79.43 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $2.63 / $3.16
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.02 / $3.02 / $3.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.51 / $1.51 / $1.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.51 / $1.51 / $2.69
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.63 / $2.63 / $2.63