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Wisconsin rates for HCPCS B4160

Enternal Formula For Pediatrics Nutritionally Complete Calorically Dense

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.34 / $0.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $1.11 / $1.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.80 / $2.11 / $3.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.77 / $0.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $1.07 / $1.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.34 / $1.07 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.65 / $3.63 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.33 / $0.61 / $1.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.42 / $0.42 / $0.42
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.83 / $0.83 / $0.83