go back

Texas rates for HCPCS B4154

Enteral Formulae Nutritionally Complete For Special Metabolic Needs Excludes Nteral Feeding Tube 100 Calories = 1 Unit (Special Coverage Instructions Apply. See Cim: 65-10 And

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.84 / $0.85 / $1.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.87 / $1.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.86 / $0.86 / $0.86
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.56 / $0.56 / $0.56
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$752.40 / $752.40 / $752.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.80 / $1.80 / $1.80
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.62 / $90.00 / $90.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $1.18 / $9.92
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.61 / $0.63 / $0.82
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.82 / $1.08 / $8.93
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.80 / $1.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.01 / $1.74
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.70 / $0.70 / $1.11