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Wisconsin rates for HCPCS B4161

Enternal Formula For Pediatrics Hydrolyzed/Amino Acids And Peptide Chain

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.13 / $1.13 / $1.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.60 / $1.87 / $3.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5.41 / $6.32 / $9.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $2.31 / $2.81
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $3.24 / $3.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.13 / $3.24 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.65 / $9.61 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.12 / $2.04 / $3.24
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.74 / $1.74 / $1.74
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4.95 / $4.95 / $4.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.16 / $2.16 / $2.38