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Texas rates for HCPCS B4150

Enteral Formula Nutritionally Complete With Intact Nutrients Includes N Enteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 A

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.47 / $0.48 / $0.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.34 / $0.49 / $0.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.48 / $0.48 / $0.48
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.29 / $101.29 / $101.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.33
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.93 / $90.00 / $90.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.42 / $0.49 / $2.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.31 / $0.35 / $0.47
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.40 / $0.49 / $1.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.33 / $0.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.35 / $0.56 / $0.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.38 / $0.38 / $0.63