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Wisconsin rates for HCPCS B4152

Enteral Formula Nutritionally Complete Calorically Dense (Equal To Or Greater Ough An Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 6

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.34 / $1.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.39 / $0.39 / $0.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $0.36 / $0.42
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.35 / $0.35 / $0.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.90 / $1.05 / $1.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.47 / $0.71
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.39 / $0.57
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.39 / $90.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.23 / $0.69 / $1.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.31 / $0.39 / $0.57
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.26 / $0.26 / $0.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.56 / $0.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.79 / $0.82 / $90.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.59 / $0.59 / $0.59
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.15 / $0.61 / $1.74