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Wisconsin rates for HCPCS B4157

Enternal Formula Nutritionally Complete For Special Metabolic Needs For

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.73 / $0.73 / $0.73
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $2.49 / $4.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $3.16 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.12 / $1.41 / $8.16
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $4.90 / $4.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $4.90 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.03 / $55.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.31 / $4.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.16 / $8.16 / $8.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3.14 / $3.14 / $3.14