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Wisconsin rates for HCPCS B4157

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

Facilitymedian $5 · 10th–90th $1–$1000%10%10th90th$5Professionalmedian $6 · 10th–90th $1–$80%50%10th90th$6$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $6.03 / $6.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.15 / $2.51 / $4.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.69 / $3.16 / $5.01
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.12 / $1.41 / $8.13
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.72 / $4.90 / $4.90
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.72 / $4.90 / $100.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.16 / $3.16 / $3.16
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $89.13
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $100.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$8.13 / $8.13 / $8.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.51 / $1.51 / $3.16