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Wisconsin rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 kcal/ml) with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $0 · 10th–90th $0–$10%50%90th$0Professionalmedian $0 · 10th–90th $0–$10%20%10th90th$0$0.2$1.0$5.0$20.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.66 / $3.02 / $3.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.40 / $0.40 / $0.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.37 / $0.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.89 / $1.05 / $1.70
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.24 / $0.47 / $0.72
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.31 / $0.39 / $0.58
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.26 / $0.26 / $0.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.31 / $0.39 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.23 / $0.63 / $1.51
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.56 / $64.57 / $89.13
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.91 / $0.91 / $0.91
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.37 / $0.58 / $1.00
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $89.13 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.24 / $0.24 / $0.24
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.58 / $0.58 / $0.58
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.58 / $0.58 / $0.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.32 / $0.40 / $0.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.15 / $0.58 / $1.41