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Texas rates for HCPCS B4152

Enteral formula, nutritionally complete, calorically dense (equal to or greater than 1.5 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.07 / $2.00 / $3.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.36 / $37.15 / $57.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.47
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.27 / $0.27 / $0.27
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.24
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $89.13 / $89.13
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.33 / $0.42 / $0.47
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.37 / $0.40 / $1.95
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.34 / $0.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $81.28 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.49 / $1.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.30 / $0.30 / $0.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.52 / $0.85