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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
Facility
Modifier
Low / Median / High Price
$0.38 / $0.39 / $0.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.40 / $0.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.40 / $0.40 / $0.40
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
$144.60 / $144.60 / $144.60
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
$0.79 / $90.00 / $90.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.42 / $1.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.31 / $0.38
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.38 / $0.49 / $1.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.24 / $0.24 / $0.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.28 / $0.47 / $0.85
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.32 / $0.32 / $0.51