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Wisconsin rates for HCPCS B4160

Enteral formula, for pediatrics, nutritionally complete calorically dense (equal to or greater than 0.7 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 $2 · 10th–90th $1–$1000%10%10th90th$2Professionalmedian $1 · 10th–90th $0–$70%10%20%10th90th$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
$1.07 / $7.08 / $7.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.95 / $1.12 / $1.12
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
$0.42 / $0.85 / $0.95
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.34 / $1.07 / $1.07
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.34 / $1.07 / $100.00
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.83 / $0.83 / $0.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.65 / $54.95 / $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
$0.42 / $0.42 / $0.42
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.14 / $2.14 / $2.14
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.83 / $0.83 / $1.07