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Texas rates for HCPCS B4153

Enteral formula, nutritionally complete, hydrolyzed proteins (amino acids and peptide chain), includes fats, carbohydrates, vitamins and minerals, may include fiber, administered through an enteral feeding tube, 100 calories = 1 unit

Facilitymedian $2 · 10th–90th $1$890%20%10th90th$2Professionalmedian $1 · 10th–90th $1$20%50%90th$1$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.00
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$1.48
Median
$1.48
Typical High
$1.48
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1.41
Median
$1.41
Typical High
$1.70
Baylor Scott & White
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.07
Typical High
$1.07
Christus
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2.45
Median
$2.45
Typical High
$2.45
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1.45
Median
$1.58
Typical High
$6.61
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1.00
Median
$1.00
Typical High
$1.62
Molina
Setting
Professional
Modifier
Global
Typical Low
$4.27
Median
$4.27
Typical High
$81.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$1.48
Median
$1.95
Typical High
$7.41
Providence
Setting
Professional
Modifier
Global
Typical Low
$0.98
Median
$2.45
Typical High
$2.45
United
Setting
Facility
Modifier
Global
Typical Low
$1.20
Median
$1.20
Typical High
$1.70
United
Setting
Professional
Modifier
Global
Typical Low
$1.07
Median
$1.82
Typical High
$2.75