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Wisconsin rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.39 / $0.42 / $1.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.46 / $0.46 / $0.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.43 / $0.43 / $0.50
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $0.41 / $0.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.05 / $1.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.47 / $0.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.46 / $0.76
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.46 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.82 / $2.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.67 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.46 / $0.76
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.70 / $1.05
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.93 / $0.99 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $0.90 / $0.90
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $0.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.19 / $0.82 / $2.12