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Wisconsin rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $1 · 10th–90th $1$10%50%90th$1Professionalmedian $1 · 10th–90th $1$20%20%10th90th$1$0.0$0.1$0.5$2.0$10.0$50.0

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
$1.00 / $1.00 / $7.08
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.81 / $0.81 / $1.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.76 / $0.76 / $0.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.82 / $2.09 / $3.39
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.41 / $1.82
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.65 / $0.79 / $1.02
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.54 / $0.54 / $0.54
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.65 / $0.79 / $89.13
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.49 / $1.35 / $3.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.23 / $64.57 / $89.13
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2.00 / $2.00 / $2.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.74 / $1.23 / $2.00
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.78 / $89.13 / $89.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.82 / $1.82 / $1.82
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.26 / $1.26 / $1.26
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.26 / $1.26 / $1.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.66 / $0.81 / $0.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.33 / $1.26 / $3.02