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Texas rates for HCPCS B4154

Enteral formula, nutritionally complete, for special metabolic needs, excludes inherited disease of metabolism, includes altered composition of proteins, fats, carbohydrates, vitamins and/or 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
$1.07 / $1.07 / $1.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.00 / $1.00 / $1.91
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.89 / $81.28 / $89.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.85 / $0.85 / $1.02
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $0.60 / $0.60
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1.82 / $1.82 / $1.82
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
$0.65 / $0.81 / $0.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.81 / $1.07 / $8.91
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.00 / $1.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2.75 / $2.75 / $81.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.83 / $1.10 / $8.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.63 / $1.82 / $1.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.66 / $0.66 / $0.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.60 / $1.12 / $1.82