go back

Wisconsin rates for HCPCS B4158

Enteral formula, for pediatrics, nutritionally complete with intact nutrients, includes proteins, fats, carbohydrates, vitamins and minerals, may include fiber and/or iron, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $4 · 10th–90th $1–$1000%10%10th90th$4Professionalmedian $1 · 10th–90th $1–$20%50%90th$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.00 / $1.00 / $2.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $1.07 / $2.29
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
$0.52 / $1.26 / $1.45
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $1.78 / $1.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.41 / $1.78 / $100.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1.45 / $1.45 / $1.45
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
$0.52 / $0.52 / $0.52
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.91 / $1.91 / $1.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.89 / $0.89 / $1.45