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Wisconsin rates for HCPCS B4162

Enternal Formula For Pediatrics Special Metabolic Needs For Inherited Disease

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 / $2.47 / $3.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.70 / $3.16 / $4.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.15 / $1.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $3.88 / $3.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.73 / $3.88 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $2.66
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.30 / $19.82 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.72 / $1.31 / $3.88
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.00 / $85.00 / $100.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.02 / $1.02 / $1.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.66 / $2.66 / $2.66